Husain A, Aptaker L, Spriggs D R, Barakat R R
Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York 10021, USA.
Gynecol Oncol. 1998 Oct;71(1):104-7. doi: 10.1006/gyno.1998.5158.
The objective of this study was to determine the incidence of grade 3 and 4 gastrointestinal toxicity and the prevalence of Clostridium difficile-associated diarrhea (CDAD) in patients with gynecologic malignancies treated with paclitaxel-based chemotherapy regimens.
We retrospectively reviewed the medical records of all patients treated on the Gynecology Service at Memorial Sloan-Kettering Cancer Center from January 1, 1993 to July 1, 1996. We identified all patients treated with paclitaxel during this period and determined the total number of patients hospitalized for symptoms of gastrointestinal toxicity, including nausea, vomiting, diarrhea, and dehydration, within 4 weeks of chemotherapy, as well as the incidence of CDAD among these patients.
Six hundred and twenty-four patients were treated with paclitaxel-containing chemotherapy regimens during the study period, including 55 patients who were treated on a "dose-dense" high-dose protocol for advanced ovarian cancer. Among these, 149 patients (24%) were hospitalized for symptoms of gastrointestinal toxicity. During the study period, a total of 40 cases of CDAD were reported among hospitalized patients on the Gynecology Service and 24 (60%) of these cases occurred in patients who had received paclitaxel within the prior 4 weeks.
The occurrence of CDAD in patients receiving paclitaxel-containing chemotherapy is not rare and can result in severe dehydration requiring hospitalization. The risk of C. difficile colitis appears to be 2.2% in patients receiving standard-dose regimens and as high as 20% in patients receiving high-dose regimens. This etiology should be considered and treated early in patients presenting with symptoms of gastrointestinal toxicity subsequent to chemotherapy treatments.
本研究的目的是确定接受以紫杉醇为基础的化疗方案治疗的妇科恶性肿瘤患者中3级和4级胃肠道毒性的发生率以及艰难梭菌相关性腹泻（CDAD）的患病率。
我们回顾性分析了1993年1月1日至1996年7月1日在纪念斯隆凯特琳癌症中心妇科接受治疗的所有患者的病历。我们确定了在此期间接受紫杉醇治疗的所有患者，并确定了化疗后4周内因胃肠道毒性症状（包括恶心、呕吐、腹泻和脱水）住院的患者总数，以及这些患者中CDAD的发生率。
在研究期间，624例患者接受了含紫杉醇的化疗方案，其中55例患者接受了晚期卵巢癌的“剂量密集”高剂量方案治疗。其中，149例患者（24%）因胃肠道毒性症状住院。在研究期间，妇科住院患者中共报告了40例CDAD，其中24例（60%）发生在过去4周内接受过紫杉醇治疗的患者中。
接受含紫杉醇化疗的患者中CDAD的发生并不罕见，可导致严重脱水需要住院治疗。接受标准剂量方案的患者中艰难梭菌结肠炎的风险似乎为2.2%，接受高剂量方案的患者中高达20%。对于化疗后出现胃肠道毒性症状的患者，应尽早考虑并治疗这种病因。
