Upper and lower limb cryotherapy as a preventive strategy for taxane-induced peripheral neuropathy in breast cancer patients: a systematic review and meta-analysis

Peripheral neuropathy is a well-known complication in patients undergoing taxane chemotherapy. Several measures to prevent this condition have been tried, but none have yielded conclusive results. MEDLINE, Embase, Cochrane, and Web of Science databases were searched for randomized (RCTs) and self-controlled (SCTs) trials comparing cryotherapy with standard care in patients with breast cancer undergoing taxane-based chemotherapy and reporting any of the following outcomes: (1) chemotherapy-induced peripheral neuropathy (CIPN) or (2) adverse events. A total of 395 patients from 10 studies were included, all female. The age of participants ranged from 49.8 to 56.1 years. Incidence of any-grade CIPN was not significantly different between groups (RCTs RR 0.59; 95% CI 0.21–1.66; <i>p</i> = 0.320; SCTs RR 0.40; 95% CI 0.10–1.62; <i>p</i> = 0.198). No difference was observed in adverse events leading to discontinuation of cryotherapy (RCTs RR 0.72; 95% CI 0.17–3.05; <i>p</i> = 0.660; SCTs RR 1.09; 95% CI 0.51–2.34; <i>p</i> = 0.821). Cryotherapy was not statistically superior to the standard of care in reducing CIPN, without an increased risk of adverse events leading to discontinuation of cryotherapy. These findings underscore the need for further studies with more rigorous methodologies to definitively validate or rule out this finding. PROSPERO (CRD420251018990).

化疗诱导性周围神经病（chemotherapy-induced peripheral neuropathy, CIPN）是接受紫杉类化疗患者的公认并发症。目前已有多种针对该病症的预防措施被尝试，但均未取得确定性研究结果。本研究检索了MEDLINE、Embase、Cochrane及Web of Science数据库，纳入比较冷冻疗法与标准护理方案在接受紫杉类化疗的乳腺癌患者中疗效的随机对照试验（randomized controlled trial, RCT）与自身对照试验（self-controlled trial, SCT），且纳入研究需报告以下任一结局指标：(1) 化疗诱导性周围神经病（CIPN），或(2) 不良事件。最终纳入10项研究共395例受试者，全部为女性，受试者年龄跨度为49.8至56.1岁。两组任意级别CIPN的发生率无显著统计学差异（随机对照试验：RR=0.59，95%CI=0.21~1.66，<i>p</i>=0.320；自身对照试验：RR=0.40，95%CI=0.10~1.62，<i>p</i>=0.198）。导致冷冻疗法中止的不良事件发生率亦未观察到组间差异（随机对照试验：RR=0.72，95%CI=0.17~3.05，<i>p</i>=0.660；自身对照试验：RR=1.09，95%CI=0.51~2.34，<i>p</i>=0.821）。冷冻疗法在降低CIPN发生率方面并未显著优于标准护理方案，且未增加导致冷冻疗法中止的不良事件风险。上述研究结果表明，亟需开展方法学更为严谨的后续研究，以明确验证或推翻该结论。本研究已在PROSPERO平台注册（CRD420251018990）。