Journals / Türk Üroloji Dergisi/Turkish Journal of Urology / 2003 / Cilt: 29 - Sayı: 3
The bone marrow toxicity of gemcitabine plus cisplatin protocol in advanced transitional cell carcinoma
- Pages
- 291–295
- DOI
- —
Abstract
Objectives: Systemic chemotherapy is a standard treatment option for patients with transitional cell carcinoma with advanced disease or who have disease progression after initial local treatment. In advanced transitional cell carcinoma different chemotherapy protocols can be used. The combination of methotrexate, vinblastine, doxorubicine and cisplatin (MVAC) is one of the most widely used regimen with reported response rates of 35% to 70%. However this treatment is associated with significant toxicity. New chemotherapy protocols are begun to be used to increase the efficacy of chemotherapy and decrease toxicity. After it has been proved by pre-clinical studies that gemcitabine has synergistic effect with cisplatin, gemcitabine has been started to be used in many cancer types' therapy, including bladder cancer. In this study we gave Gemcitabine+Cisplatin (GC) chemotheraphy protocol to 13 advanced transitional cell carcinoma patients and we evaluated the bone marrow toxicity due to chemotheraphy. Material and Methods: Between May 2001 and May 2002 in our clinic we used GC chemotherapy protocol in 13 male patients who had advanced transitional cell carcinoma. Mean age value was 67 (range between 52 and 79). Of these 13 patients 2 had liver metastasis, 2 had pulmonary metastasis, 1 had bone metastasis and 3 had local invasion. We gave neoadjuvant chemotherapy to 3 patients adjuvant chemotheraphy to 2 patients. According to TNM classification 5 patients were stage T4N3M1, 7 patients were T3bNOMO and 1 patient was T3bN1MO We gave 4 cyles chemotheraphy -one cure is 28 days- to all of the patients. On the lst,8th and 15th days we gave gemcitabine 1000 mg/m2 and on the 2nd day we gave cisplatin 70 mg/m2. We analyzed the hemograms, liver function tests and renal function tests of every patient before and after the treatment. Granulocyte stimulation factors, granulocyte -macrophage stimulation factors, RBC transfusion and platelet transfusion were given to patients with anemia, leukopenia and thrombocytopenia. All the adverse effects during chemotherapy were noted and body temperatures of the patients were followed up. The toxicities were evaluated according to WHO toxicity criters. Results: In 3 patients (23%) bone marrow toxicity was observed. Gastrointestinal adverse effects were seen in 4 patients (30%) during chemotheraphy. In patients with bone marrow toxicity, 1 patient had grade 4, 2 patients had grade 3 thrombocytopenia and 1 patient had grade 3 anemia. One patient died because of cardio-pulmonary arrest. Conclusion: GC chemotherapy protocol is a very tolerable and effective treatment for transitional cell carcinoma; with less bone marrow toxicity.
Özet
Sistemik kemoterapi, lokal tedavi sonrası progresyon gösteren veya ilerlemiş hastalığı olan değişici epitel hücreli kanserli (DEHK) hastalarda standart tedavi yöntemidir. Yaptığımız bu çalışmada ileri evre DEHK'i mevcut 13 hastaya uygulanan Gemsitabin+Sispilatin (GS) kemoterapi protokolünün kemik iliğine (k.i.) toksik yan etkileri değerlendirildi. Mayıs 2001-Mayıs 2002 tarihleri arasında kliniğimizde ileri evre DEHK mevcut 13 erkek hastaya GS kemoterapi protokolü başlandı. Hastaların ortalama yaşı 67 (52-79) idi. 13 hastanın; 2'sinde karaciğer metastazı, 2'sinde akciğer metastazı, 1'inde kemik metastazı, 3'ünde lokal invazyon mevcuttu. Radikal sistektomi planlanan 3 hastaya neoadjuvan, 2 hastaya ise radikal sistektomi sonrası adjuvan kemoterapi verildi. TNM sınıflandırmasına göre 5 hasta T4N3M1, 7 hasta T3bN0M0 ve l hasta T3bN1M0 idi. Hastalara 28 günlük kürler şeklinde toplam 4 kür tedavi verildi. Kür tedavisi 1, 8., ve 15. günlerde 1000 mg/m2 ye gemsitabin ve kürün 2. günü 70 mg/m2 sispilatin şeklinde verildi.Tedavi öncesi ve tedavi sonrası tüm hastalardan hemogram, karaciğer fonksiyon testleri ve böbrek fonksiyon testleri için kan alındı. Anemi, lökopeni ve trombositopenisi gelişen hastalara granülosit stimule edici faktörler, granülosit-makrofaj stimule edici faktör, eritrosit süspansiyonu ve trombosit süspansiyonları destek amacıyla verildi. Kemoterapi süresinde gelişen toksik yan etkiler kaydedildi ve ateş takibi yapıldı. Kemoterapiye bağlı gelişen toksisiteler WHO (Dünya Sağlık Örgütü) toksisite kriterlerine göre değerlendirildi. WHO'nun toksisite kriterlerine göre 3 hastada (%23) k.i. toksisitesi saptandı. 4 hastada (%30) kemoterapi süresince gastrointestinal yan etkiler görüldü. Kemik iliği toksisitesi gelişen hastalardan birinde grade 4, ikisinde grade 3 lökopeni, 2 hastada grade 3 nötropeni, 2 hastada grade 3 trombositopeni ve l hastada grade 3 anemi görüldü. l hastada kardiyo-pulmoner arreste bağlı eksitus görüldü. GS kemoterapi protokolü DEHK'li hastalarda tolère edilebilir, düşük kemik iliği toksisiteli ve etkili bir kemoterapi yöntemidir.