Authors: (including presenting author): :
Lee YT(1), Liu YT (2), Kowk PW (3), Yeung I(3), Wong CY(3), Mui WH(3),Chan LY(4), Ho PS(3), Tsoi SY(5), Kwan WS(1), Lam WS(1), Mak MY(1)
Affiliation: :
(1) Department of Physiotherapy, Tuen Mun Hospital (2) Department of Physiotherapy, Tin Shui Wai Hospital (3) Department of Clinical Oncology, Tuen Mun Hospital (4) Department of Medicine & Geriatrics, Tuen Mun Hospital (5) Department of Clinical Oncology, Tin Shui Wai Hospital
Keyword 1: :
Chemotherapy-induced peripheral neuropathy
Keyword 2: :
Nasopharyngeal carcinoma
Keyword 3: :
Exercise therapy
Keyword 4: :
Physiotherapy
Keyword 5: :
Quality of life
Introduction: :
Chemotherapy-induced peripheral neuropathy (CIPN) is a dose-limiting toxicity in patients with locoregionally advanced nasopharyngeal carcinoma (NPC) treated with gemcitabine-cisplatin induction chemotherapy and concurrent chemoradiotherapy (CRT), with historical incidence up to 81.7% (Zhang et al., 2025). There is randomized data and systematic review evidence supporting exercise therapy in preventing CIPN.
Objectives: :
This pilot study evaluated the feasibility and preliminary efficacy of a tailored physiotherapy exercise program for preventing and managing CIPN.
Methodology: :
Twenty-two patients (19 males, 3 females; mean age 52.2 ± 10.4 years) with locoregionally advanced NPC were enrolled. A seven-session exercise program (face-to-face and telehealth) was delivered from pre-chemotherapy to 12 months post-CRT, targeting CIPN prevention, fibrosis management, and physical function maintenance. Outcomes included CIPN incidence and grade (CTCAE v5.0), chemotherapy dose modifications, patient-reported neurotoxicity and quality of life (FACT/GOG-Ntx), lower-limb strength (30-second Chair Stand Test), exercise tolerance (6-Minute Walk Test), and patient satisfaction. Nerve conduction studies (NCS) and electromyography (EMG) were performed.
Result & Outcome: :
Of 22 enrolled patients, 12 completed post-treatment assessment. Clinically assessed CIPN occurred in 6 patients (50%), all Grade 1—markedly lower than historical controls. No chemotherapy dose reductions or delays due to CIPN were required. Neurotoxicity scores increase slightly (36.58 → 32.33, NS), whereas overall QOL improved (107.96 → 114.11). Lower-limb strength and walking distance remained stable. Patient satisfaction was high (mean 9.25/10). 11 patients (91.7%) developed varying degrees of sensory-predominant axonopathy, with 5 (41.7%) showing values below normal limits. This pilot physiotherapy-led exercise program, incorporating telehealth, was feasible, highly acceptable, and associated with substantially lower clinically significant CIPN (50% Grade 1 only) despite objective evidence of subclinical axonal injury in most patients. Physical function and QOL were preserved. The findings are consistent with published data suggesting that early exercise intervention may help mitigate symptomatic CIPN in NPC patients undergoing platinum-based treatment. These results support the development of a larger-scale service program for patients, potentially extending beyond those with NPC.
