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Risk stratification of oxaliplatin induced peripheral neurotoxicity applying electrophysiological testing of dorsal sural nerve

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We aimed to verify the predictiveness of dorsal sural nerve neurophysiological monitoring in obtaining risk stratification for oxaliplatin-induced peripheral neurotoxicity (OXAPN).


We conducted a secondary analysis on a cohort of 110 colorectal cancer patients who were evaluated clinically and neurophysiologically before chemotherapy, at mid-treatment and at discontinuation. We applied the classification tree analysis method to predict the end-of-treatment OXAPN neurophysiological diagnosis, using data recorded at mid-treatment. We then ascertained the correlation between the obtained classes and neurological impairment at the end of treatment (Fisher’s exact test).


Dorsal sural nerve monitoring enabled us to stratify oxaliplatin-treated patients into risk classes with an implemented approach to neurophysiology application in this setting. Neurological outcome at discontinuation was predicted by neurophysiological monitoring performed during chemotherapy administration.


We demonstrated the role that neurophysiology may play in clinical trials as an early surrogate marker that can predict OXAPN development at the end of treatment. Specifically, we propose abnormal dorsal sural sensory nerve testing as an early biomarker in identifying patients at high risk of eventually developing OXAPN.

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We thankfully acknowledge the patients who participated in this study and Miss Laura Merriam Reynolds for the language revision.

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Correspondence to Paola Alberti.

Ethics declarations

The study had obtained approval from the ethics review board of each participating center [IRB number approval for each center: 12474/14.05.2008 (Patras, Greece), 215/06 (Barcelona, Spain), 1999P/18.01.2010 (Padua, Italy), 442/29.07.2010 (Monza, Italy)], and the participants provided written informed consent.

Conflict of interest

GC is an expert advisory board member to design a neuroprotection clinical trial for PledPharma and is a recipient of AIRC grant IG2016-18631 (competitive research grant to investigate on chemotherapy-induced peripheral neurotoxicity and strategies to reduce its severity). The other authors have nothing to disclose. The authors have full control of primary data.

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Alberti, P., Rossi, E., Argyriou, A.A. et al. Risk stratification of oxaliplatin induced peripheral neurotoxicity applying electrophysiological testing of dorsal sural nerve. Support Care Cancer 26, 3143–3151 (2018).

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