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Alarcón-Barrios S, Luvián-Morales J, Castro-Eguiluz D, Delgadillo-González M, Lezcano-Velázquez BO, Arango-Bravo EA, Flores-Cisneros L, Aguiar Rosas S, Cetina-Pérez L. Chemoradiotherapy treatment with gemcitabine improves renal function in locally advanced cervical cancer patients with renal dysfunction. Curr Probl Cancer 2024; 48:101041. [PMID: 37988902 DOI: 10.1016/j.currproblcancer.2023.101041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 10/23/2023] [Accepted: 11/07/2023] [Indexed: 11/23/2023]
Abstract
BACKGROUND 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. METHODS 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. RESULTS 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). CONCLUSION 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.
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Affiliation(s)
- Silvia Alarcón-Barrios
- 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
| | - Julissa Luvián-Morales
- MICAELA Program, Instituto Nacional de Cancerología, Mexico City, Mexico; Department of Clinical Research, Instituto Nacional de Cancerología, Mexico City, Mexico
| | - Denisse Castro-Eguiluz
- Consejo Nacional de Humanidades, Ciencia y Tecnología (CONAHCyT) Department of Clinical Research, Instituto Nacional de Cancerología, Mexico City, Mexico
| | - Merari Delgadillo-González
- MICAELA Program, Instituto Nacional de Cancerología, Mexico City, Mexico; Department of Clinical Research, Instituto Nacional de Cancerología, Mexico City, Mexico
| | - Brenda Olivia Lezcano-Velázquez
- MICAELA Program, Instituto Nacional de Cancerología, Mexico City, Mexico; Department of Pain Clinic, Instituto Nacional de Cancerología, Mexico City, Mexico
| | - Eder Alexandro Arango-Bravo
- MICAELA Program, Instituto Nacional de Cancerología, Mexico City, Mexico; Department of Clinical Research, Instituto Nacional de Cancerología, Mexico City, Mexico; Department of Gynecologic Oncology, Instituto Nacional de Cancerología, Mexico City, Mexico
| | | | - Sebastián Aguiar Rosas
- 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
| | - Lucely Cetina-Pérez
- MICAELA Program, Instituto Nacional de Cancerología, Mexico City, Mexico; Department of Clinical Research, Instituto Nacional de Cancerología, Mexico City, Mexico; Department of Gynecologic Oncology, Instituto Nacional de Cancerología, Mexico City, Mexico.
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