title: Chemotherapy-induced peripheral neurotoxicity can be misdiagnosed by the National Cancer Institute Common Toxicity scale.
abstract: The assessment of chemotherapy-induced peripheral neurotoxicity (CIPN) is still uncertain as several of the most frequently used scales do not rely on a formal neurological evaluation and depend on patients' reports and examiners' interpretations. The aim of this study was to compare the assessment of CIPN using the National Cancer Institute Common Toxicity Criteria (NCI-CTC) scale and a formal neurological assessment scored with the Total Neuropathy Score (TNS, i.e., a composite scale designed to grade the impairment in neuropathy patients) to identify possible discrepancies in the diagnosis. In this prospective study, 155 patients treated with cisplatin/carboplatin or with paclitaxel/docetaxel and CIPN were examined in a collaborative oncological/neurological multi-center trial using the NCI-CTC scale and the TNS; the results were then extensively compared. We evidenced that the TNS allows possible misdiagnosed neuropathies to be revealed. In fact, the NCI-CTC evaluation performed by experienced examiners overestimated the occurrence of motor neuropathy, possibly because of the presence of confounding factors (e.g., fatigue, depression, cachexia), which might be difficult to be ruled out without a formal neurological examination. This study strongly indicates that a more formal neurological assessment of patients with CIPN than that achievable with the common toxicity scales (e.g., NCI-CTC) is advisable.
authors: Clinica Neurologica, Azienda Ospedaliera S. Gerardo, Monza, Italy.
authors: Barbara
authors: B
authors: Frigeni
authors: Marialuisa
authors: M
authors: Piatti
authors: Francesca
authors: F
authors: Lanzani
authors: Paola
authors: P
authors: Alberti
authors: Patrizia
authors: P
authors: Villa
authors: Claudio
authors: C
authors: Zanna
authors: Maurizio
authors: M
authors: Ceracchi
authors: Massimo
authors: M
authors: Ildebrando
authors: Guido
authors: G
authors: Cavaletti
mesh_terms: D000970:Antineoplastic Agents / Q000009:adverse effects*; D003951:Diagnostic Errors; D005260:Female; D006801:Humans; D008297:Male; D054547:National Cancer Institute (U.S.); D009460:Neurologic Examination / Q000379:methods; D020258:Neurotoxicity Syndromes / Q000175:diagnosis* / Q000209:etiology; D010523:Peripheral Nervous System Diseases / Q000139:chemically induced / Q000175:diagnosis*; D012720:Severity of Illness Index; D014481:United States
chemical_list: D000970:Antineoplastic Agents