Alarcón-Barrios Silvia, Luvián-Morales Julissa, Castro-Eguiluz Denisse, Delgadillo-González Merari, Lezcano-Velázquez Brenda Olivia, Arango-Bravo Eder Alexandro, Flores-Cisneros Laura, Aguiar Rosas Sebastián, Cetina-Pérez Lucely
Programa de Maestría y Doctorado en Ciencias de la Salud, Universidad Nacional Autónoma de México, Mexico City, México; MICAELA Program, Instituto Nacional de Cancerología, Mexico City, Mexico; Department of Clinical Research, Instituto Nacional de Cancerología, Mexico City, Mexico; Department of Pain Clinic, Instituto Nacional de Cancerología, Mexico City, Mexico.
MICAELA Program, Instituto Nacional de Cancerología, Mexico City, Mexico; Department of Clinical Research, Instituto Nacional de Cancerología, Mexico City, Mexico.
Curr Probl Cancer. 2024 Feb;48:101041. doi: 10.1016/j.currproblcancer.2023.101041. Epub 2023 Nov 20.
Cervical cancer (CC) in Mexico is diagnosed mainly in locally advanced (LACC) and advanced (ACC) stages, where ureteral obstruction is more frequent. The standard treatment for this population is concurrent chemoradiotherapy (CCRT) with cisplatin, which is nephrotoxic and could lead to further deterioration of renal function in LACC patients with renal function decline. We aimed to evaluate the effect of CCRT with Gemcitabine on renal function in LACC patients.
This retrospective study included LACC patients treated with CCRT with Gemcitabine as a radiosensitizer from February 2003 to December 2018. Data were collected from medical archives and electronic records. We assessed renal function before and after CCRT treatment and analyzed the patient's response to treatment and survival.
351 LACC patients treated were included and stratified into two groups: 198 with Glomerular Filtration Rate (GFR) ≥60ml/min (group A) and 153 with GFR<60ml/min (group B). An improvement in GFR was observed after CCRT in patients in group B, from 33 ml/min to 57.5 ml/min (p<0.001). Complete response was observed in 64.1% of patients in Group A and 43.8% in Group B (p<0.0001). Factors associated with increased risk of death included having a GFR of 15-29 ml/min (HR: 2.17; 1.08-4.35), having GFR<15 ml/min (HR: 3.08; 1.63-5.79), and receiving Boost treatment (HR: 2.09; 1.18-3.69). On the other hand, receiving brachytherapy is a positive predictor for OS (HR:0.51; 0.31-0.84).
CCRT with gemcitabine is an appropriate treatment option for patients diagnosed with LACC who present impaired renal function due to the disease's obstructive nature or other comorbidities.
在墨西哥，宫颈癌（CC）主要在局部晚期（LACC）和晚期（ACC）阶段被诊断出来，输尿管梗阻在这些阶段更为常见。该人群的标准治疗方法是顺铂同步放化疗（CCRT），顺铂具有肾毒性，可能导致肾功能下降的LACC患者的肾功能进一步恶化。我们旨在评估吉西他滨同步放化疗对LACC患者肾功能的影响。
这项回顾性研究纳入了2003年2月至2018年12月期间接受以吉西他滨作为放射增敏剂的同步放化疗的LACC患者。数据从医疗档案和电子记录中收集。我们评估了同步放化疗前后的肾功能，并分析了患者的治疗反应和生存情况。
纳入了351例接受治疗的LACC患者，并将其分为两组：198例肾小球滤过率（GFR）≥60ml/分钟（A组）和153例GFR<60ml/分钟（B组）。B组患者在同步放化疗后观察到GFR有所改善，从33ml/分钟提高到57.5ml/分钟（p<0.001）。A组64.1%的患者和B组43.8%的患者观察到完全缓解（p<0.0001）。与死亡风险增加相关的因素包括GFR为15 - 29ml/分钟（HR：2.17；1.08 - 4.35）、GFR<15ml/分钟（HR：3.08；1.63 - 5.79）以及接受强化治疗（HR：2.09；1.18 - 3.69）。另一方面，接受近距离放射治疗是总生存期的一个积极预测因素（HR：0.51；0.31 - 0.84）。
对于因疾病阻塞性质或其他合并症而出现肾功能受损的LACC确诊患者，吉西他滨同步放化疗是一种合适的治疗选择。
