Simultaneous chemoradiation with cisplatin in a patient with recurrent cervical cancer undergoing hemodialysis: analysis of cisplatin concentrations in serum and dialysate and therapy-related acute toxicity

Abstract

Purpose: To prove the feasibility and toxicity of platinum-based chemoradiation in a patient with recurrent cervical cancer undergoing concomitant hemodialysis.

Patient and methods: We report a patient with a renal transplant because of chronic renal failure who then underwent radical hysterectomy and lymphadenectomy due to cervical cancer FIGO stage IB1. One year after primary therapy, a 53 × 54 × 68 mm vaginal stump recurrence was treated by total translevatoric exenteration with lymphadenectomy, explantation of the transplant, and the right residual kidney. Because of microscopically involved margins, chemoradiation was recommended. Radiation was performed to the tumor region and pelvic lymph nodes up to 50.4 Gy. A boost was given to the clip-marked region to 66.6 Gy. Neurological, gastrointestinal and genitourinary toxicity was evaluated once a week, while hematological toxicity twice per week. Samples to evaluate cisplatin concentrations were taken from blood and dialysate.

Results: The patient completed chemoradiation with 5 cisplatin applications with a decreased dose (20 mg/m(2)) without any high grade toxicity. Hemodialysis was performed three times a week. Within 30 min after cisplatin application, the cisplatin serum concentration reached the highest level with 1,179.6 µg/l and showed nearly stable concentrations over 120 min. There was an accumulation of cisplatin from week 1 (100%) to week 5 of application (219%). The corresponding concentration in the dialysate also showed a rapid increase within the first hour of hemodialysis and decreased to 50% within 2 h.

Conclusion: Cisplatin application with a modified dose (20 mg/m(2)) is feasible and safe in a patient with cervical carcinoma undergoing chemoradiation and hemodialysis.