Comparison of two chemotherapy-induced peripheral neuropathy measurement approaches in children.
OBJECTIVE
Chemotherapy-induced peripheral neuropathy (CIPN) is a common side effect of cancer treatment in children; however, measurement of CIPN has been hampered by limitations in available tools, which may impact prevalence estimates. The purpose of this study was to assess the relative ability of the Common Terminology Criteria (CTCAE) rating process to detect sensory and motor neuropathy as compared to administration of the pediatric modified Total Neuropathy Score (peds-mTNS).


METHODS
The ped-mTNS was administered to 60 children/adolescents ages 5-18 undergoing treatment for acute lymphocytic leukemia, lymphoma, or non-CNS solid tumors. CTCAE v3.0 scores for the same time point were abstracted from the medical record by a separate trained rater. Comparisons were made between scores using descriptive statistics, correlations, and specificity and sensitivity calculations.


RESULTS
The median ped-mTNS score was 9 (32 possible), while the median sensory and motor CTCAE ratings were 0 and 2, respectively (4 and 5 possible, respectively). There was no correlation between ped-mTNS and combined sensory and motor CTCAE scores. The only ped-mTNS item with significant correlation to CTCAE scoring was strength testing. Medical record abstraction of CTCAE scores failed to identify sensory neuropathy in 40 % and significant motor neuropathy (manual muscle test grade 3 or worse) in 15 % of subjects.


CONCLUSIONS
Prospective measures of CIPN using the ped-mTNS identified a far greater proportion of subjects with peripheral neurotoxicity as compared to CTCAE v3.0 sensory and motor neuropathy ratings, and thus we recommend the use of a specific measure of CIPN such as the ped-mTNS.
Physical Therapy Program, St. Catherine University, 601 25th Ave S, Minneapolis, MN, USA, lsgilchrist@stkate.edu.
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D000293:Adolescent; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects* / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D002945:Cisplatin / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D005260:Female; D006801:Humans; D060828:Induction Chemotherapy; D008223:Lymphoma / Q000188:drug therapy; D008297:Male; D009369:Neoplasms / Q000188:drug therapy; D020258:Neurotoxicity Syndromes / Q000175:diagnosis* / Q000188:drug therapy / Q000209:etiology; D010523:Peripheral Nervous System Diseases / Q000139:chemically induced* / Q000175:diagnosis* / Q000188:drug therapy; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000188:drug therapy; D011446:Prospective Studies; D014750:Vincristine / Q000008:administration & dosage / Q000009:adverse effects
D014750:Vincristine; D002945:Cisplatin