Preventive Effect Of Different Doses Of Ca/Mg Infusion On Oxaliplatin-induced Neurotoxicity

Objectives1. To investigate the clinical manifestations and electrophysiological changes of oxaliplatin-induced neurotoxicity.2. To evaluate the preventive effect of different doses of magnesium sulfate and calcium gluconate in combination on oxaliplatin-induced neurotoxicity.Methods A case-control study method was adopted.45 cancer patients who were given oxaliplatin chemotherapy from April 2009 to March 2010 in Shandong Provincial Hospital were divided into three groups, that is pure chemotherapeutic group, chemotherapy combined with low dosage of Ca/Mg group and chemotherapy combined with middle dosage of Ca/Mg group. We investigated the clinical manifestations and electrophysiological changes of oxaliplatin-induced neurotoxicity, evaluated the preventive effect of Ca/Mg on oxaliplatin-induced neurotoxicity and compared the electrophysiological index value of oxaliplatin-induced neurotoxicity between different doses of Ca/Mg group. Statistical analysis were performed using SPSS software V16.0. Comparison between two groups was performed using the chi-square test, unpaired t-test or non-parametric means test for continuous variables. A P-value of <0.05 was considered statistically significant.Results1. Acute Neurotoxicity:All patients were evaluated within 48 h after the first cycle of oxaliplatin infusion. Prior to administration of oxaliplatin, the electrophysiological examination of all patients showed no obvious abnormality and none of the patients had repetitive CMAP(compound muscle action potential). After infusion of oxaliplatin,80% of patients in the pure chemotherapy group(12/15) had positive clinical manifestations of acute neurotoxicity, and while these patients with positive performance,91.7%(11/12) had repetitive CMAP, electrophysiological changes coincided with clinical manifestations.After administration of oxaliplatin, the number of repetitive CMAP had statistical difference among the three groups (P<0.05). Compared with the pure chemotherapy, chemotherapy with low dose of Ca/Mg group and chemotherapy with middle dosage of Ca/Mg group had less repetitive CMAP, the difference was statistically significant (P<0.05), however, the latter two groups showed no statistical difference (P= 0.739).2. Chronic neurotoxicity:Prior to administration of oxaliplatin, SNAP (sensory nerve action potential) amplitude of the three groups (the baseline value) had no significant difference (F= 0.059 P= 0.943), and the SNAP amplitude of the baseline value was 10.722±2.1481mV. After cycles 5/6 of oxaliplatin, the SNAP amplitudes of pure chemotherapy group, chemotherapy with low dose of Ca/Mg group and chemotherapy with middle dosage of Ca/Mg group were less than baseline values, with statistical differences (P< 0.05). SNAP amplitude values were statistically different within the three groups (F= 4.864 P= 0.013). Compared with pure chemotherapy group, the SNAP amplitude of chemotherapy with low dose of Ca/Mg group and chemotherapy with middle dosage of Ca/Mg group were greater with statistical differences (P<0.05), however, the latter two groups showed no statistical difference (P= 0.981).3. During the study, dosage of oxaplatin did not reduced and discontinued because of its sevious neurotoxicity.4. During the treatment, it did not appear the calcium and magnesium induced adverse effect.Conclusions1. Oxaliplatin-induced acute neurotoxicity had high incidence, and the electrophysiological changes coincided with clinical manifestations.2. Ca/Mg mixture was beneficial within the prevention of oxaliplatin-induced acute and chronic neurotoxicity,however, the preventive effect was not strengthened with the increase of dosage.3. Ca/Mg mixture was economic and safe within the dosage range of this experiment.