Nasolacrimal Obstruction in Patients treated with Docetaxel (Taxotere) For Early Breast Cancer

Adam Gajdatsy FRANZCO⁴, Arlene Chan FRACP¹, Charles Su FRANZCO³ ,Richard de Boer FRACP², Andrea Provis¹, Felicity Osmond², Andrew Whyte⁵, Mark Scott³,

¹Mount Hospital Perth, ²Epworth-Freemasons Hospital Melbourne, ³Eye & Ear Hospital Melbourne, ⁴Lions Eye Institute Perth, ⁵Perth Radiological Clinic, Australia

Background: Many women receiving adjuvant chemotherapy for early breast cancer (EBC) report a variety of ocular symptoms. Epiphora has been reported in patients receiving docetaxel in the metastatic setting. The incidence of tear drainage obstruction in those receiving docetaxel-based chemotherapy in the adjuvant setting (early, non-metastatic disease) has not been studied previously.

Methods: 102 consecutive pts without pre-existing epiphora who received adjuvant docetaxel -based chemotherapy regimens at 2 cancer centres for EBC were enrolled. All patients received standard chemotherapy doses. Each patient had three ophthalmological assessments: pre-chemotherapy, mid-way through the regimen (interim result) and 3 months post completion. A CT-Dacryocystogram (CT-DCG) was performed at baseline and 3 months after completion of chemotherapy. At each chemotherapy visit patients completed an eye symptom questionnaire.

Results: Epiphora developed rapidly, persisted during chemotherapy but rapidly subsided after treatment completion. The proportion of patients with both epiphora and no degree of syringing obstruction at the interim examination = 88.6% (39/44). The proportion of patients who developed tearing by the end of their chemotherapy was 70% (71/102). In 12 of these patients this was associated with some degree of new onset obstruction to nasolacrimal syringing. Radiologic evidence of newly developed obstruction occurred in 9 eyes. There was, however, only a 65% correlation between radiologic and irrigation findings.

Conclusions: These data suggest that in early breast cancer patients treated with Docetaxel, nasolacrimal obstruction accounts for a small proportion of tearing symptoms. The case for prophylactic stenting of such patients is not supported by this study.