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- Title
Oncological treatment of ovarian neoplasm in the context of hemodialysis.
- Authors
Lăcustoiu, Cătălina; Popescu, Oana; Marinescu, Irina Anghel,Ştefania; Tolea, Mădălina; Pîslariu, Anca; Gener, Ismail; Niţipir, Cornelia
- Abstract
Objective. Optimizing cytotoxic drug handling in terms of dosage adjustment and time of administration regarding the dialysis sessions. Materials and method. We present the case of a patient with locally advanced epithelial ovarian cancer, with acute renal failure, requiring hemodialysis. Results. A 56yearold patient had elevated ROMA (Ovarian Malignancy Risk Algorithm) score and locally advanced bilateral ovarian carcinoma, with abdominopelvic peritoneal carcinomatosis with proposed imaging staging T3c N0 M0. The intraoperative biopsy confirmed ovarian serous carcinoma FIGO (International Federation of Gynecology and Obstetrics) stage IIIC and peritoneal carcinomatosis. After complete tumor cytoreduction surgery, intraperitoneal hyperthermic chemotherapy was performed with cisplatin 100 mg for 60 minutes at 41 degrees Celsius, using the Coliseum technique. The patient developed acute renal failure, as a reaction to cisplatin administration, with hemodialysis requirement (stage III KDIGO – Kidney Disease Improving Global Outcomes). Our team decided to administer paclitaxel 175 mg/m² and carboplatin in reduced doses, followed by hemodialysis 24 hours after the administration of carboplatin for a period of 4 hours, according to international studies and guidelines. Paclitaxel is metabolized mainly in the liver, with a little influence of hemodialysis on its pharmacokinetics. The carboplatin dose was calculated by the Calvert formula, considering that the eGFR (estimated glomerular filtration rate) was 0 ml/min. The patient is currently undergoing hemodialysis twice a week and with diuresis of approximately 1.5 L/day. The nephrology team recommended diuretics on the day of treatment and dapagliflozin, which is a sodiumglucose inhibitor with a good nephroprotective effect on the proximal renal tube, the main site of nephrotoxicity for carboplatin. Conclusions. The combination of paclitaxel and carboplatin can be administered to an advancedstage epithelial ovarian cancer patient with advanced nitrogen retention. To ensure a favorable therapeutic effect with limited side effects, the hemodialysis should be initiated 24 hours after the administration of carboplatin.
- Subjects
PERITONEAL cancer; OVARIAN epithelial cancer; HYPERTHERMIC intraperitoneal chemotherapy; HEMODIALYSIS; OVARIAN tumors; ACUTE kidney failure; CYTOREDUCTIVE surgery; ANTINEOPLASTIC agents
- Publication
Oncolog-Hematolog, 2021, Issue 55, p40
- ISSN
2066-8716
- Publication type
Article