title: The impact of paclitaxel and carboplatin chemotherapy on the autonomous nervous system of patients with ovarian cancer.
abstract: BACKGROUND
  Paclitaxel-based regimens are frequently associated with the development of peripheral neuropathy. The autonomous nervous system (ANS) effects, however, of this chemotherapeutic agent remain unexplored.
  
  
  METHODS
  We investigated a group of 31 female patients with ovarian cancer receiving treatment with paclitaxel and carboplatin, as well as a group of 16 healthy age- and gender-matched healthy volunteers. All study participants completed a questionnaire and were assessed neurophysiologically at three time points (baseline, 3-4 months and 6-8 months following the onset of chemotherapy). The evaluation of the ANS included assessment of the adrenergic cardiovascular function (orthostatic hypotension-OH), parasympathetic heart innervation (30/15 ratio) and sympathetic skin response (SSR).
  
  
  RESULTS
  At the 3-4 months ANS assessment, 19.2 % of the patients had systolic OH and the same percentage had diastolic OH, but at the 6-8 months evaluation no patient had systolic OH and only 13.8 % had diastolic OH. The values of the 30/15 ratio were significantly reduced at both time points, whereas the SSR was not affected.
  
  
  CONCLUSIONS
  Combined paclitaxel and carboplatin chemotherapy is associated with significant effects on the parasympathetic heart innervation and occasionally with effects on the adrenergic cardiovascular reaction. The SSR remained unaffected. Physicians should be alert to the possibility of these treatment-emergent side effects, so as to monitor ANS parameters and introduce treatment modifications accordingly. Our findings however, should be validated in larger cohorts.
authors.affiliation: Laboratory of Clinical Neurophysiology, Department of Neurology, "Papageorgiou" Hospital, Thessaloniki, 564 03, Greece. manolis.dermitzakis@gmail.com.
authors.forename: Emmanouil V
authors.initials: EV
authors.lastname: Dermitzakis
authors.affiliation: Laboratory of Clinical Neurophysiology, Aristotle University of Thessaloniki, Faculty of Medicine, Thessaloniki, Greece.
authors.forename: Vasilios K
authors.initials: VK
authors.lastname: Kimiskidis
authors.affiliation: Department of Medical Oncology, School of Health Sciences, Faculty of Medicine, "Papageorgiou" Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece.
authors.forename: George
authors.initials: G
authors.lastname: Lazaridis
authors.affiliation: Department of Biostatistics, Health Data Specialists Ltd, Athens, Greece.
authors.forename: Zoi
authors.initials: Z
authors.lastname: Alexopoulou
authors.affiliation: Department of Medical Oncology, School of Health Sciences, Faculty of Medicine, "Papageorgiou" Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece.
authors.forename: Eleni
authors.initials: E
authors.lastname: Timotheadou
authors.affiliation: First Department of Obstetrics and Gynecology, School of Health Sciences, Faculty of Medicine, "Papageorgiou" Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece.
authors.forename: Alexandros
authors.initials: A
authors.lastname: Papanikolaou
authors.affiliation: Department of Medical Oncology, School of Health Sciences, Faculty of Medicine, "Papageorgiou" Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece.
authors.forename: Ourania
authors.initials: O
authors.lastname: Romanidou
authors.affiliation: Neurological Department, "Hippocration" General Hospital, Thessaloniki, Greece.
authors.forename: George
authors.initials: G
authors.lastname: Georgiadis
authors.affiliation: Laboratory of Molecular Oncology, Hellenic Foundation for Cancer Research/Aristotle University of Thessaloniki, Thessaloniki, Greece.|Translational Research Section, Hellenic Cooperative Oncology Group, Data Office, Athens, Greece.
authors.forename: Konstantine T
authors.initials: KT
authors.lastname: Kalogeras
authors.affiliation: Laboratory of Clinical Neurophysiology, Department of Neurology, "Papageorgiou" Hospital, Thessaloniki, 564 03, Greece.
authors.forename: Iakovos
authors.initials: I
authors.lastname: Tsiptsios
authors.affiliation: First Department of Obstetrics and Gynecology, School of Health Sciences, Faculty of Medicine, "Papageorgiou" Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece.
authors.forename: Basil
authors.initials: B
authors.lastname: Tarlatzis
authors.affiliation: Laboratory of Molecular Oncology, Hellenic Foundation for Cancer Research/Aristotle University of Thessaloniki, Thessaloniki, Greece.
authors.forename: George
authors.initials: G
authors.lastname: Fountzilas
mesh_terms: D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000009:adverse effects*; D001341:Autonomic Nervous System / Q000187:drug effects*; D001342:Autonomic Nervous System Diseases / Q000139:chemically induced*; D016190:Carboplatin / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008875:Middle Aged; D010051:Ovarian Neoplasms / Q000188:drug therapy*; D017239:Paclitaxel / Q000009:adverse effects*
chemical_list: D000970:Antineoplastic Agents; D016190:Carboplatin; D017239:Paclitaxel
keywords: 30/15 ratio; Autonomous nervous system; Orthostatic hypotension; Paclitaxel; Sympathetic skin response