epoetin-alfa and Peripheral-Nervous-System-Diseases

The purpose of this study is to discuss current controversies surrounding the proposed treatments for traumatic optic neuropathy (TON) and review recent evidence from the literature relating to these therapeutic options.. No recent randomized controlled trials investigating surgical or medical interventions for TON exist. The current literature regarding treatment of TON consists mainly of small, mostly retrospective, observational studies. Treatment of TON with corticosteroids, surgical decompression of the optic canal or combinations of surgery and corticosteroids does not appear to offer improved visual outcomes compared with observation alone. Recent evidence suggests that there may be diminished functional reserve of the optic nerve following trauma. Novel neuroprotective therapies, such as erythropoietin, are currently under investigation in the treatment of TON.. TON may lead to profound visual disability. Because of the absence of Class I evidence relating to treatment of TON, a lack of consensus exists among clinicians regarding the appropriate treatment for TON. Our review of the recent literature finds that there is still no reliable evidence that treatment of TON with corticosteroids, surgical optic canal decompression or both confers any benefit over observation alone, and yet these interventions incur an additional risk that may not warrant their routine use.

Topics: Decompression, Surgical; Epoetin Alfa; Glucocorticoids; Humans; Optic Nerve; Optic Nerve Injuries; Peripheral Nervous System Diseases

As the antitumor activity of radiation is mediated via its interaction with oxygen to form labile free radicals, the intratumoral oxygen level has an important influence on the ability of radiation therapy to kill malignant cells. By decreasing the oxygen-carrying capacity of the blood, anemia may result in tumor hypoxia and may have a negative influence on the outcome of radiotherapy for various malignancies, even for small tumors not normally assumed to be hypoxic. In addition, anemia also has a negative effect on the quality of life of cancer patients, as evidenced by worsening fatigue. As a high proportion (about 50%) of cancer patients undergoing radiotherapy are anemic prior to or during treatment, strategies to correct anemia and/or the resultant tumor hypoxia are increasingly being considered an important component of treatment. In particular, epoetin alfa (recombinant human erythropoietin), which has proved an effective and well-tolerated means of raising hemoglobin levels in anemic patients receiving radiotherapy, potentially could reverse the negative prognostic influence of a low hemoglobin in patients with certain malignancies. Radiation oncologists need to be aware of the possibility of anemia in cancer patients undergoing radiotherapy so that timely intervention can be instituted whenever anemia is diagnosed.

Topics: Anemia; Epoetin Alfa; Erythropoietin; Hematinics; Humans; Neoplasms; Peripheral Nervous System Diseases; Predictive Value of Tests; Prevalence; Prognosis; Quality of Life; Radiotherapy; Recombinant Proteins; Survival Analysis; Treatment Outcome