Abstract

PurposeMagnetic resonance neurography (MRN) can detect dorsal root ganglia (DRG) hypertrophy in patients with oxaliplatin-induced peripheral neuropathy (OXIPN) but is difficult to apply in clinical daily practice. Aims of this study were (i) to assess whether DRG volume is reliably measurable by routine computed tomography (CT) scans, (ii) to measure longitudinal changes in DRG during and after oxaliplatin administration and (iii) to assess correlation between DRG morphometry and individual oxaliplatin dose.MethodsFor comparison of MRN and CT measurements, CT scans of 18 patients from a previous MRN study were analyzed. For longitudinal assessment of DRG size under treatment, 96 patients treated with oxaliplatin between January and December 2014 were enrolled retrospectively. DRG volumetry was performed by analyzing routine CT scans, starting with the last scan before oxaliplatin exposure (t0) and up to four consecutive timepoints after initiation of oxaliplatin therapy (t1–t4) with the following median and ranges in months: 3.1 (0.4–4.9), 6.2 (5.3–7.8), 10.4 (8.2–11.9), and 18.4 (12.8–49.8).ResultsDRG volume measured in CT showed a moderately strong correlation with MRN (r = 0.51, p < 0.001) and a strong correlation between two consecutive CTs (r = 0.77, p < 0.001). DRG volume increased after oxaliplatin administration with a maximum at timepoint t2. Higher cumulative oxaliplatin exposure was associated with significantly higher absolute DRG volumes (p = 0.005). Treatment discontinuation was associated with a nonsignificant trend towards lower relative DRG volume changes (p = 0.08).ConclusionCT is a reliable method for continuous DRG morphometry; however, since no standardized assessment of OXIPN was performed in this retrospective study, correlations between DRG size, cumulative oxaliplatin dose and clinical symptoms in future prospective studies are needed to establish DRG size as a potential OXIPN biomarker.

Highlights

  • The third-generation platinum compound oxaliplatin (OXA) is used as standard of care in chemotherapy regimens for most gastrointestinal malignancies, including colorectal, gastric and pancreatic cancer [1,2,3]

  • To determine the most suitable size parameter for dorsal root ganglia (DRG) assessment and reliability of consecutive measurements, both volume and area were compared between magnetic resonance imaging (MRI) and computed tomography (CT) before and after the MRI (Fig. 2)

  • The DRG size measured in CT showed a moderate correlation with MRI for area (r = 0.50, p < 0.001) as well as for volume (r = 0.51, p < 0.001)

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Summary

Introduction

The third-generation platinum compound oxaliplatin (OXA) is used as standard of care in chemotherapy regimens for most gastrointestinal malignancies, including colorectal, gastric and pancreatic cancer [1,2,3]. OXA has a manageable toxicity profile regarding hematologic, gastrointestinal and renal side effects; chronic oxaliplatin-induced peripheral neuropathy (OXIPN) can cause progressive longterm neurological deficits and serious functional difficulties in daily life, severely reducing the quality of life [4, 5]. These adverse effects are dose-limiting, making OXIPN the main cause of dose reductions or discontinuation of OXAbased treatment and compromising therapeutic outcome [6]. Assessing the extent of damage to the PNS is difficult due to its anatomical dissemination, and electrophysiological methods can only indirectly and functionally investigate the DRG

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