MA Zahra, A Taylor, G Mould, C Coles, R Crawford, LT Tan
Clin Oncol (R Coll Radiol)
AIMS: Concurrent cisplatin chemo-radiotherapy improves outcome in cervical carcinoma. In haemodialysis patients, cisplatin is potentially hazardous. We report the treatment of a haemodialysis patient with cervix cancer using cisplatin-based chemo-radiation. Mathematical modelling using toxicity data from a range of cisplatin dosages and schedules reported in published studies was undertaken. MATERIALS AND METHODS: The patient was treated using weekly cisplatin chemotherapy 25mg/m(2). The serum platinum levels were measured. Correlations between reported toxicity and platinum levels for a variety of cisplatin schedules in published studies were evaluated. RESULTS: Treatment was completed with no interruptions and minimum acute toxicity. The platinum levels rose progressively. The elimination half-life was prolonged at 6.6-7.5 days. The percentage extraction varied between 7.7 and 41.0%. The cumulative cisplatin dose correlated with neurotoxicity (P=0.002). Myelotoxicity correlated with the peak cisplatin level in the first 15 days of treatment (P=0.01). With an elimination half-life of 7.5 days, 35 mg/m(2) weekly is predicted to have the same risk of myelotoxicity and neurotoxicity as 40 mg/m(2) weekly in a patient with normal renal function. CONCLUSIONS: Weekly cisplatin chemotherapy 25mg/m(2) can be delivered safely in a haemodialysis patient. Dialysis is effective in eliminating platinum even if carried out more than 3h after infusion, but it should commence as soon as possible after cisplatin infusion, as the incidence of myelotoxicity is related to the peak platinum level.