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Safety and tolerability of cryocompression as a method of enhanced limb hypothermia to reduce taxane-induced peripheral neuropathy

PURPOSE: Severe peripheral neuropathy is a common dose-limiting toxicity of taxane chemotherapy, with no effective treatment. Frozen gloves have shown to reduce the severity of neuropathy in several studies but comes with the incidence of undesired side effects such as cold intolerance and frostbite...

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Autores principales: Bandla, Aishwarya, Tan, Stacey, Kumarakulasinghe, Nesaretnam Barr, Huang, Yiqing, Ang, Sally, Magarajah, Gayathiri, Hairom, Zarinah, Lim, Joline Si Jing, Wong, Alvin, Chan, Gloria, Ngoi, Natalie, Ang, Emily, Lee, Yee Mei, Chan, Amanda, Lee, Soo-Chin, Thakor, Nitish, Wilder-Smith, Einar, Sundar, Raghav
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer Berlin Heidelberg 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7316694/
https://www.ncbi.nlm.nih.gov/pubmed/31811482
http://dx.doi.org/10.1007/s00520-019-05177-2
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author Bandla, Aishwarya
Tan, Stacey
Kumarakulasinghe, Nesaretnam Barr
Huang, Yiqing
Ang, Sally
Magarajah, Gayathiri
Hairom, Zarinah
Lim, Joline Si Jing
Wong, Alvin
Chan, Gloria
Ngoi, Natalie
Ang, Emily
Lee, Yee Mei
Chan, Amanda
Lee, Soo-Chin
Thakor, Nitish
Wilder-Smith, Einar
Sundar, Raghav
author_facet Bandla, Aishwarya
Tan, Stacey
Kumarakulasinghe, Nesaretnam Barr
Huang, Yiqing
Ang, Sally
Magarajah, Gayathiri
Hairom, Zarinah
Lim, Joline Si Jing
Wong, Alvin
Chan, Gloria
Ngoi, Natalie
Ang, Emily
Lee, Yee Mei
Chan, Amanda
Lee, Soo-Chin
Thakor, Nitish
Wilder-Smith, Einar
Sundar, Raghav
author_sort Bandla, Aishwarya
collection PubMed
description PURPOSE: Severe peripheral neuropathy is a common dose-limiting toxicity of taxane chemotherapy, with no effective treatment. Frozen gloves have shown to reduce the severity of neuropathy in several studies but comes with the incidence of undesired side effects such as cold intolerance and frostbite in extreme cases. A device with thermoregulatory features which can safely deliver tolerable amounts of cooling while ensuring efficacy is required to overcome the deficiencies of frozen gloves. The role of continuous-flow cooling in prevention of neurotoxicity caused by paclitaxel has been previously described. This study hypothesized that cryocompression (addition of dynamic pressure to cooling) may allow for delivery of lower temperatures with similar tolerance and potentially improve efficacy. METHOD: A proof-of-concept study was conducted in cancer patients receiving taxane chemotherapy. Each subject underwent four-limb cryocompression with each chemotherapy infusion (three hours) for a maximum of 12 cycles. Cryocompression was administered at 16 °C and cyclic pressure (5–15 mmHg). Skin surface temperature and tolerance scores were recorded. Neuropathy was assessed using clinician-graded peripheral sensory neuropathy scores, total neuropathy score (TNS) and nerve conduction studies (NCS) conducted before (NCS(pre)), after completion (NCS(post)) and 3 months post-chemotherapy (NCS(3m)). Results were retrospectively compared with patients who underwent paclitaxel chemotherapy along with continuous-flow cooling and controls with no hypothermia. RESULTS: In total, 13 patients underwent 142 cycles of cryocompression concomitant with chemotherapy. Limb hypothermia was well tolerated, and only 1 out of 13 patients required an intra-cycle temperature increase, with no early termination of cryocompression in any subject. Mean skin temperature reduction of 3.8 ± 1.7 °C was achieved. Cryocompression demonstrated significantly greater skin temperature reductions compared to continuous-flow cooling and control (p < 0.0001). None of the patients experienced severe neuropathy (clinician-assessed neuropathy scores of grade 2 or higher). NCS analysis showed preservation of motor amplitudes at NCS(3m) in subjects who underwent cryocompression, compared to the controls who showed significant deterioration (NCS(3m) cryocompression vs. NCS(3m) control: ankle stimulation: 8.1 ± 21.4%, p = 0.004; below fibula head stimulation: 12.7 ± 25.6%, p = 0.0008; above fibula head stimulation: 9.4 ± 24.3%, p = 0.002). Cryocompression did not significantly affect taxane-induced changes in sensory nerve amplitudes. CONCLUSION: When compared to continuous-flow cooling, cryocompression permitted delivery of lower temperatures with similar tolerability. The lower skin surface temperatures achieved potentially lead to improved efficacy in neurotoxicity amelioration. Larger studies investigating cryocompression are required to validate these findings. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s00520-019-05177-2) contains supplementary material, which is available to authorized users.
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spelling pubmed-73166942020-07-01 Safety and tolerability of cryocompression as a method of enhanced limb hypothermia to reduce taxane-induced peripheral neuropathy Bandla, Aishwarya Tan, Stacey Kumarakulasinghe, Nesaretnam Barr Huang, Yiqing Ang, Sally Magarajah, Gayathiri Hairom, Zarinah Lim, Joline Si Jing Wong, Alvin Chan, Gloria Ngoi, Natalie Ang, Emily Lee, Yee Mei Chan, Amanda Lee, Soo-Chin Thakor, Nitish Wilder-Smith, Einar Sundar, Raghav Support Care Cancer Original Article PURPOSE: Severe peripheral neuropathy is a common dose-limiting toxicity of taxane chemotherapy, with no effective treatment. Frozen gloves have shown to reduce the severity of neuropathy in several studies but comes with the incidence of undesired side effects such as cold intolerance and frostbite in extreme cases. A device with thermoregulatory features which can safely deliver tolerable amounts of cooling while ensuring efficacy is required to overcome the deficiencies of frozen gloves. The role of continuous-flow cooling in prevention of neurotoxicity caused by paclitaxel has been previously described. This study hypothesized that cryocompression (addition of dynamic pressure to cooling) may allow for delivery of lower temperatures with similar tolerance and potentially improve efficacy. METHOD: A proof-of-concept study was conducted in cancer patients receiving taxane chemotherapy. Each subject underwent four-limb cryocompression with each chemotherapy infusion (three hours) for a maximum of 12 cycles. Cryocompression was administered at 16 °C and cyclic pressure (5–15 mmHg). Skin surface temperature and tolerance scores were recorded. Neuropathy was assessed using clinician-graded peripheral sensory neuropathy scores, total neuropathy score (TNS) and nerve conduction studies (NCS) conducted before (NCS(pre)), after completion (NCS(post)) and 3 months post-chemotherapy (NCS(3m)). Results were retrospectively compared with patients who underwent paclitaxel chemotherapy along with continuous-flow cooling and controls with no hypothermia. RESULTS: In total, 13 patients underwent 142 cycles of cryocompression concomitant with chemotherapy. Limb hypothermia was well tolerated, and only 1 out of 13 patients required an intra-cycle temperature increase, with no early termination of cryocompression in any subject. Mean skin temperature reduction of 3.8 ± 1.7 °C was achieved. Cryocompression demonstrated significantly greater skin temperature reductions compared to continuous-flow cooling and control (p < 0.0001). None of the patients experienced severe neuropathy (clinician-assessed neuropathy scores of grade 2 or higher). NCS analysis showed preservation of motor amplitudes at NCS(3m) in subjects who underwent cryocompression, compared to the controls who showed significant deterioration (NCS(3m) cryocompression vs. NCS(3m) control: ankle stimulation: 8.1 ± 21.4%, p = 0.004; below fibula head stimulation: 12.7 ± 25.6%, p = 0.0008; above fibula head stimulation: 9.4 ± 24.3%, p = 0.002). Cryocompression did not significantly affect taxane-induced changes in sensory nerve amplitudes. CONCLUSION: When compared to continuous-flow cooling, cryocompression permitted delivery of lower temperatures with similar tolerability. The lower skin surface temperatures achieved potentially lead to improved efficacy in neurotoxicity amelioration. Larger studies investigating cryocompression are required to validate these findings. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s00520-019-05177-2) contains supplementary material, which is available to authorized users. Springer Berlin Heidelberg 2019-12-06 2020 /pmc/articles/PMC7316694/ /pubmed/31811482 http://dx.doi.org/10.1007/s00520-019-05177-2 Text en © The Author(s) 2019 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.
spellingShingle Original Article
Bandla, Aishwarya
Tan, Stacey
Kumarakulasinghe, Nesaretnam Barr
Huang, Yiqing
Ang, Sally
Magarajah, Gayathiri
Hairom, Zarinah
Lim, Joline Si Jing
Wong, Alvin
Chan, Gloria
Ngoi, Natalie
Ang, Emily
Lee, Yee Mei
Chan, Amanda
Lee, Soo-Chin
Thakor, Nitish
Wilder-Smith, Einar
Sundar, Raghav
Safety and tolerability of cryocompression as a method of enhanced limb hypothermia to reduce taxane-induced peripheral neuropathy
title Safety and tolerability of cryocompression as a method of enhanced limb hypothermia to reduce taxane-induced peripheral neuropathy
title_full Safety and tolerability of cryocompression as a method of enhanced limb hypothermia to reduce taxane-induced peripheral neuropathy
title_fullStr Safety and tolerability of cryocompression as a method of enhanced limb hypothermia to reduce taxane-induced peripheral neuropathy
title_full_unstemmed Safety and tolerability of cryocompression as a method of enhanced limb hypothermia to reduce taxane-induced peripheral neuropathy
title_short Safety and tolerability of cryocompression as a method of enhanced limb hypothermia to reduce taxane-induced peripheral neuropathy
title_sort safety and tolerability of cryocompression as a method of enhanced limb hypothermia to reduce taxane-induced peripheral neuropathy
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7316694/
https://www.ncbi.nlm.nih.gov/pubmed/31811482
http://dx.doi.org/10.1007/s00520-019-05177-2
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