Horan G, McArdle O, Martin J, Collins C D, Faul C
Oncology Centre, Box 193, Addenbrooke's Hospital, Hills Road, Cambridge, CB2 2QQ, UK.
Gynecol Oncol. 2006 Jun;101(3):441-4. doi: 10.1016/j.ygyno.2005.11.005. Epub 2005 Dec 9.
Many patients with Stage IIIB cervix cancer (Ca) and hydronephrosis will require ureteral stenting. The timing is important as delays or prolonged overall treatment times adversely affect outcome. Our aim was to measure the effect of pelvic radiotherapy (R/T) on renal function and identify a subset of patients at high risk of acute urinary obstruction during R/T.
From 1/1/2000 to 1/1/2002, all patients with Stage IIIB cervix Ca and hydronephrosis were analysed retrospectively. To quantify the impact of pelvic R/T, all eligible patients from 1/7/2002-1/7/2004 had prospectively recorded baseline biochemistry, creatinine clearance and renal ultrasounds; these were repeated weekly to detect any change in renal function or degree of hydronephrosis.
13 eligible patients were analysed retrospectively, 5 with unilateral hydronephrosis with 40% requiring urinary diversion (UD). 8 had bilateral hydronephrosis, with 75% requiring UD; 50% before R/T and 35% during R/T. Average creatinine clearance (CrCl) was 74 mL/min (1.24 mL/s) in unilateral hydronephrosis , bilateral = 52 mL/min (0.87 mL/s), in those stented during R/T it was < 40 mL/min (0.67 mL/s). The resulting break in R/T was 6 and 19 days. In the prospective study, 5 patients were eligible and 4 consented. 75% had unilateral hydronephrosis and did not require UD with an average CrCl = 71 mL/min (1.19 mL/s). 1 patient with bilateral hydronephrosis had a CrCl of < 20 mL/min (0.33 mL/s) with bilateral stents placed before R/T.
Patients with bilateral hydronephrosis and a low CrCl < 50 mL/min (0.84 mL/s) should be considered for elective UD prior to R/T. Pelvic R/T did not induce any deterioration in renal function or degree of hydronephrosis.
许多III B期宫颈癌（Ca）合并肾积水的患者需要输尿管支架置入。时机很重要，因为延迟或延长总体治疗时间会对预后产生不利影响。我们的目的是评估盆腔放疗（R/T）对肾功能的影响，并确定在放疗期间发生急性尿路梗阻高风险的患者亚组。
对2000年1月1日至2002年1月1日期间所有III B期宫颈癌合并肾积水的患者进行回顾性分析。为了量化盆腔放疗的影响，对2002年7月1日至2004年7月1日期间所有符合条件的患者前瞻性记录基线生化指标、肌酐清除率和肾脏超声检查结果；每周重复检查以检测肾功能或肾积水程度的任何变化。
对13例符合条件的患者进行回顾性分析，5例为单侧肾积水，其中40%需要尿液改道（UD）。8例为双侧肾积水，75%需要尿液改道；放疗前50%，放疗期间35%。单侧肾积水患者的平均肌酐清除率（CrCl）为74 mL/min（1.24 mL/s），双侧肾积水患者为52 mL/min（0.87 mL/s），放疗期间置入支架的患者<40 mL/min（0.67 mL/s）。放疗中断时间分别为6天和19天。在前瞻性研究中，5例患者符合条件，4例同意。75%为单侧肾积水，无需尿液改道，平均肌酐清除率=71 mL/min（1.19 mL/s）。1例双侧肾积水患者肌酐清除率<20 mL/min（0.33 mL/s），在放疗前双侧置入支架。
双侧肾积水且肌酐清除率低<50 mL/min（0.84 mL/s）的患者应在放疗前考虑择期尿液改道。盆腔放疗未导致肾功能或肾积水程度恶化。
