Canalicular stenosis secondary to weekly versus every-3-weeks docetaxel in patients with metastatic breast cancer.
Canalicular stenosis secondary to weekly versus every-3-weeks docetaxel in patients with metastatic breast cancer.
复制标题
转移性乳腺癌患者每周与每 3 周多西他赛治疗后继发的小管狭窄。
DOI：
10.1016/s0161-6420(02)00989-2
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发表时间：
2002
期刊：
影响因子：
13.7
通讯作者：
Valero,Vicente
中科院分区：
文献类型：
--
作者：
Esmaeli,Bita;Hortobagyi,GabrielN;Esteva,FranciscoJ;Booser,Daniel;Ahmadi,MAmir;Rivera,Edgardo;Arbuckle,Rebecca;Delpassand,Ebrahim;Guerra,Laura;Valero,Vicente
目的比较转移性乳腺癌患者每周和每 3 周多西紫杉醇副作用引起的小管狭窄的频率。设计回顾性非随机比较试验。患者和方法 18 名患者参加了每周多西他赛加曲妥珠单抗的 II 期研究，18 名患者参加了每 3 周多西他赛加曲妥珠单抗的 II 期研究 评估了阿霉素。每个患者都接受了全面的眼科检查、鼻泪管探查和冲洗，在某些情况下还进行了泪道核扫描。 主要观察指标如果患者报告溢泪（过度流泪），则记录其发病时间。在溢泪患者中，根据探诊和冲洗的结果评估是否存在泪小管狭窄。记录每例多西紫杉醇治疗的持续时间、剂量频率和多西紫杉醇的累积剂量。结果每周接受多西紫杉醇加曲妥珠单抗治疗的14名患者（77%）出现流溢。其中九名患者的泪小管有明显的解剖学狭窄。建议对所有九名患者进行双泪管硅胶插管或泪囊鼻腔吻合术。八名患者接受了手术，溢泪完全或接近完全消失。尽管每 3 周接受一次多西他赛加阿霉素治疗的两名患者 (11%) 报告有短暂的溢泪症状，但两名患者均未发现泪小管变窄，且溢溢的严重程度不足以需要手术干预。本研究中患者多西紫杉醇治疗的平均持续时间为 19 周。患有泪管狭窄的患者多西紫杉醇的平均累积剂量高于没有这种副作用的患者。结论 对于转移性乳腺癌，每周接受多西紫杉醇治疗的患者比每 3 周接受多西紫杉醇治疗的患者更常见。应考虑在每周多西他赛治疗过程的早期进行双泪小管硅胶插管，因为这种干预可以防止泪小管完全闭合。一旦发生泪小管完全或接近完全狭窄，可能需要放置永久性派热克斯玻璃管来克服泪液流出的阻塞。
PURPOSETo compare the frequency of canalicular stenosis as a side effect of weekly versus every-3-weeks docetaxel in patients with metastatic breast cancer.DESIGNRetrospective nonrandomized comparative trial.PATIENTS AND METHODSEighteen patients enrolled in a phase II study of weekly docetaxel plus trastuzumab and 18 patients enrolled in a phase II study of every-3-weeks docetaxel plus doxorubicin were evaluated. Each patient underwent a comprehensive ophthalmologic examination, probing and irrigation of the nasolacrimal duct, and, in some instances, a nuclear lacrimal scan.MAIN OUTCOME MEASURESIf epiphora (excessive tearing) was reported by the patient, its time of onset was documented. In patients with epiphora, presence or absence of canalicular stenosis was evaluated on the basis of the findings on probing and irrigation. The duration of treatment with docetaxel, the dose frequency, and the cumulative dose of docetaxel were recorded in each case.RESULTSFourteen patients (77%) receiving weekly docetaxel plus trastuzumab had epiphora. Nine of these patients had significant anatomic narrowing of the canaliculi. Bicanalicular silicone intubation or dacryocystorhinostomy was recommended in all nine patients. Eight patients underwent surgery and experienced complete or near complete resolution of epiphora. Although two patients (11%) receiving every-3-weeks docetaxel plus doxorubicin reported transient symptoms of epiphora, neither patient was found to have narrowing of the canaliculi, and the epiphora was not severe enough to justify surgical intervention. The mean duration of docetaxel therapy for the patients in this study was 19 weeks. The mean cumulative dose of docetaxel was higher in patients with canalicular stenosis than in patients without this side effect.CONCLUSIONSCanalicular stenosis was more common in patients receiving weekly docetaxel than in those receiving every-3-weeks docetaxel for metastatic breast cancer. Bicanalicular silicone intubation early in the course of weekly docetaxel therapy should be considered, because this intervention can prevent complete closure of the canaliculi. Once complete or near complete stenosis of the canaliculi occurs, placement of a permanent Pyrex glass tube may become necessary to overcome the blockage of tear outflow.