Methotrexate tolerance in patients with ileal conduits and continent diversions.
BACKGROUND
Methotrexate is readily absorbed from the intestinal tract. When given to patients with urinary diversion to the intestinal tract, methotrexate may be reabsorbed into the circulation, thus increasing its serum concentration and potentially increasing its toxicity.


METHODS
Forty-eight patients with transitional cell carcinoma of the urinary tract who had undergone cystectomy and either an ileal conduit or a continent diversion were evaluated for their tolerance of chemotherapy. Of the 42 evaluable patients, 23 had a continent diversion and 19 had an ileal conduit. None of the patients with the continent diversion had an indwelling Foley catheter during the course of chemotherapy.


RESULTS
There were no statistically significant differences in incidence of fever or neutropenia, mucositis, dose modification, or delay in chemotherapy between the two groups. When compared with a group of patients with native bladders who received the same chemotherapy, patients with continent diversions did not have increased incidence or severe toxicity from chemotherapy.


CONCLUSIONS
Patients with continent diversions tolerated chemotherapy as well as patients with ileal conduits.
Srinivas
S
S
Division of Oncology, Veterans Affairs Medical Center, Palo Alto, California 94304, USA.
Mahalati
K
K
Freiha
F S
FS
D000964:Antimetabolites, Antineoplastic / Q000009:adverse effects* / Q000494:pharmacology; D002295:Carcinoma, Transitional Cell / Q000188:drug therapy*; D015653:Cystectomy; D004361:Drug Tolerance; D005260:Female; D006801:Humans; D008297:Male; D008727:Methotrexate / Q000009:adverse effects* / Q000494:pharmacology; D008875:Middle Aged; D014547:Urinary Diversion; D014571:Urologic Neoplasms / Q000188:drug therapy*
D000964:Antimetabolites, Antineoplastic; D008727:Methotrexate