Nadroparine activated fibrinolysis and improvement of glomerular filtration rate in patients with FIGO IIB-IIIB cervical cancer treated with radiochemotherapy.
OBJECTIVE
(1) Evaluation of the influence of hemostatic disorders on renal function in patients with FIGO stage IIB-IIIB cervical cancer treated with radiochemotherapy. (2) Identifying methods of improving renal function in this patients group.


METHODS
Treatment design assumes the administration of a total radiation dose of 46-65 Gy and, additionally, cisplatin 40 mg/m2 every 7 days in patients with normal plasma creatinine level. Renal function was assessed with the aid of dynamic scintigraphy with glomerular filtration rate (GFR) evaluation. Analysis of serum hemostatic system covered D-dimers, PAP, PAI-1, tPA, FDP, F1+2 and TAT. The same hemostatic parameters were also evaluated in urine. The patients were divided into two groups: the study group - i.e. patients with affected GFR and the control group - with normal GFR. Half of study group patients, throughout the entire treatment, receive nadroparine 2850 units aXa/0.3 ml every 24 h during and 6 weeks after the treatment.


RESULTS
There are significant decreases of GFR in control (median -9.7%) and study group without nadroparine (median -9.9%) and increase in the GFR (median 22.3%) in study group with nadroparine (p=0.0001). Plasma and urine hemostatic parameter analysis showed activation of fibrinolysis in patients treated with nadroparine and fibrinolysis inhibition in remaining groups.


CONCLUSIONS
(1) Inhibition of fibrinolysis may cause subclinical renal insufficiency in patients with advanced cervical cancer. (2) Insufficiency increases after the end of radiochemotherapy in patients, as well with normal GFR as, with primary decreased GFR. (3) Application of nadroparine causes fibrinolysis activation, and increase in the GFR.
Derlatka
Pawel
P
Department of Gynecological Oncology Cancer Center, The Maria Sklodowska-Curie Memorial, WK Roentgena 5 st, 02-781 Warsaw, Poland. larajpawel@neostrada.pl
Bidzinski
Mariusz
M
Stachurska
Ewa
E
Benke
Malgorzata
M
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002945:Cisplatin / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D005260:Female; D005342:Fibrinolysis / Q000187:drug effects; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D005919:Glomerular Filtration Rate / Q000187:drug effects; D006801:Humans; D007668:Kidney / Q000098:blood supply / Q000187:drug effects; D007674:Kidney Diseases / Q000097:blood / Q000188:drug therapy* / Q000209:etiology*; D008875:Middle Aged; D017762:Nadroparin / Q000627:therapeutic use*; D009367:Neoplasm Staging; D011446:Prospective Studies; D012079:Renal Circulation / Q000187:drug effects; D002583:Uterine Cervical Neoplasms / Q000097:blood* / Q000188:drug therapy / Q000532:radiotherapy / Q000628:therapy*
D005343:Fibrinolytic Agents; D017762:Nadroparin; D002945:Cisplatin