Chemoradiation with gemcitabine for cervical cancer in patients with renal failure.
The prognosis of cervical cancer patients with renal failure secondary to obstructive uropathy is poor. Our objective was to analyze our experience in the management with chemoradiation of untreated cervical cancer patients complicated by obstructive nephropathy and kidney dysfunction. Untreated patients with cervical cancer and renal failure as manifested by raised serum creatinine were treated with pelvic radiotherapy concurrently with weekly gemcitabine at 300 mg/m2. Response, toxicity and renal function pre- and post-therapy were evaluated. Eight FIGO stage IIIB and one IVB patients were treated. Pre-treatment serum creatinine ranged from 1.6 to 18.5 mg/100 ml (median 3.3, mean 6.8) and creatinine clearance varied from 4 to 57 mg/ml/min (median 17, mean 22.1). Four patients had a percutaneous nephrostomy placed and four patients had symptoms from kidney failure. All patient completed chemoradiation. Most patients had grade 3 leukopenia and neutropenia. Dermatitis, colitis and proctitis were common. All patients had improvement in creatinine clearance (pre-therapy 22.78, post-therapy 54.3 mg/ml/min) (p=0.0058) and all but one normalized serum creatinine. Eight (89%) of nine patients achieved complete response and one patient had persistence. At a median follow-up of 11 months (range 6-14), all patients are alive, one with pelvic and another with systemic disease. Ureteral obstruction causing any degree of renal insufficiency should not be a contraindication to receive chemoradiation to attempt cure. In this setting where cisplatin-based therapy is contraindicated, the use of gemcitabine may be considered.
Cetina
Lucely
L
Division of Clinical Research, National Cancer Institute/Institute of Biomedical Research, National Autonomous University of México. Mexico City, Mexico.
Rivera
Lesbia
L
Candelaria
Myrna
M
de la Garza
Jaime
J
Dueñas-González
Alfonso
A
D001918:Brachytherapy / Q000379:methods; D002294:Carcinoma, Squamous Cell / Q000150:complications / Q000188:drug therapy / Q000532:radiotherapy; D017024:Chemotherapy, Adjuvant / Q000379:methods*; D003404:Creatinine / Q000097:blood; D003841:Deoxycytidine / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000627:therapeutic use* / Q000633:toxicity; D004334:Drug Administration Schedule; D004341:Drug Evaluation / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007275:Injections, Intravenous; D007677:Kidney Function Tests / Q000379:methods; D008800:Mexico; D008875:Middle Aged; D009367:Neoplasm Staging; D011838:Radiation-Sensitizing Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D018714:Radiotherapy, Adjuvant / Q000379:methods*; D051437:Renal Insufficiency / Q000150:complications / Q000188:drug therapy*; D013997:Time Factors; D016896:Treatment Outcome; D014524:Urethral Obstruction / Q000150:complications; D002583:Uterine Cervical Neoplasms / Q000150:complications / Q000188:drug therapy* / Q000532:radiotherapy*; D000093542:Gemcitabine
D011838:Radiation-Sensitizing Agents; D003841:Deoxycytidine; D003404:Creatinine; D000093542:Gemcitabine