İntraperitoneal hipertermik kemoterapi epitelyal yumurtalık kanseri olan hastalarda postoperatif hipomagnezemi riskini artırır

Abstract

Amaç: İntraperitoneal hipertermik kemoterapi (HİPEK), maksimal sitoredüktif cerrahiyi (SC) takiben epitelyal yumurtalık kanseri (EYK) olan hastalar için ortaya çıkan bir tedavi yöntemidir. Bu çalışma, SC-HİPEK uygulanan EYK hastalarında yüksek serum kreatinin düzeyleri olmadan hipomagnezemi gelişimini değerlendirmeyi amaçlamaktadır. Gereç ve Yöntemler: Eylül 2014-Ağustos 2018 tarihleri arasında İstanbul'daki iki üçün basamak hastanede SC sonrası HIPEC uygulanan ileri evre EYK hastalarını (n = 43) inceleyen retrospektif bir çalışmadır. Bulgular: Bu retrospektif çalışmaya toplam 43 EYK hastası dahil edildi. Bunlardan sekizi dahil edilme kriterlerini karşıladı. Bu çalışmada hipomagnezemi insidansı %18,6 olarak bulundu. Ortalama hipomagnezemi başlangıç süresi üç gündü (aralık, 1-6 gün). Sisplatin ile tedavi edilen 32 hastanın beşinde (%15,6), karboplatin ile tedavi edilen 10 hastanın 2'sinde (%10) ve mitomisin C ile tedavi edilen bir hastada hipomagnezemi gelişti. Hiçbir hastada nörolojik bir semptom saptanmadı. Sonuç: SC-HİPEK uygulanacak EOC hastalarının tedavisinde hipomagnezemi dahil çoklu morbiditeler düşünülmelidir. Hipomagnezemi, SC-HİPEK ile ilişkili potansiyel bir komplikasyondur ve ameliyat öncesi tahmin edilemez. Bu çalışmanın sonuçları hipomagnezemiyi ekarte etmek ve erken tedavisini saptamak için ameliyat öncesi ve sonrası dönemde magnezyum düzeylerinin rutin olarak ölçülmesini önermektedir.

Keywords

• yumurtalık kanseri,HİPEK,sisplatin,hipomagnezemi,nefrotoksisite

Hyperthermic intraperitoneal chemotherapy increases the risk for postoperative hypomagnesemia in patients with epithelial ovarian cancer

Abstract

Objective: Hyperthermic intraperitoneal chemotherapy (HIPEC) is an emerging treatment modality for patients with epithelial ovarian cancer (EOC) following maximal cytoreductive surgery (CRS). This study aims to evaluate the development of hypomagnesemia without elevated serum creatinine levels in patients with EOC who underwent CRS-HIPEC. Materials and Methods: It was a retrospective study analyzing the patients (n=43) with advanced stage EOC undergoing HIPEC following the CRS at two tertiary hospitals in Istanbul between September 2014 and August 2018. Results: A total of 43 patients with EOC were enrolled in this retrospective study. Eight of them met the inclusion criteria. The incidence of hypomagnesemia was found as 18.6% in this study. The mean onset time of hypomagnesemia was three days (range, 1-6 days). Hypomagnesemia developed in five of 32 patients (15.6%) treated with cisplatin, 2 of 10 patients (10%) treated with carboplatin, and one patient treated with mitomycin C. None of the patients had a neurological symptom. Conclusion: Multiple morbidities, including hypomagnesemia, must be considered in the management of patients with EOC undergoing CRS-HIPEC. Hypomagnesemia is a potential complication associated with CRS-HIPEC, and it cannot be predicted preoperatively. The results of this study suggest routine measurement of magnesium levels in the preoperative and postoperative period in order to rule out hypomagnesemia and when found its early management.

Keywords

• ovarian cancer,HIPEC,cisplatin,hypomagnesemia,nephrotoxicity

References

1. 1. Segal R, Miller K, Jemal A. Cancer statistics, 2018. CA Cancer J Clin. 2018;68:7-30.
2. 2. Van Driel WJ, Koole SN, Sikorska K, Schagen van Leeuwen JH, Schreuder HW, Hermans RH, et al. Hyperthermic intraperitoneal chemotherapy in ovarian cancer. New England Journal of Medicine. 2018;378(3):230-40.
3. 3. Dagel T, Misirlioglu S, Tanju S, Afsar B, Selcukbiricik F, Erus S, et al. Hyperthermic intraperitoneal chemotherapy is an independent risk factor for development of acute kidney injury. Journal of BU ON: official journal of the Balkan Union of Oncology. 2018;23(5):1528-33.
4. 4. Hakeam HA, Breakiet M, Azzam A, Nadeem A, Amin T. The incidence of cisplatin nephrotoxicity post hyperthermic intraperitoneal chemotherapy (HIPEC) and cytoreductive surgery. Renal failure. 2014;36(10):1486-91.
5. 5. Sin EI-L, Chia CS, Tan GHC, Soo KC, Teo MC-C. Acute kidney injury in ovarian cancer patients undergoing cytoreductive surgery and hyperthermic intra-peritoneal chemotherapy. International Journal of Hyperthermia. 2017;33(6):690-5.
6. 6. Cashin PH, Ehrsson H, Wallin I, Nygren P, Mahteme H. Pharmacokinetics of cisplatin during hyperthermic intraperitoneal treatment of peritoneal carcinomatosis. European journal of clinical pharmacology. 2013;69(3):533-40.
7. 7. Zhou H, Wu W, Tang X, Zhou J, Shen Y. Effect of hyperthermic intrathoracic chemotherapy (HITHOC) on the malignant pleural effusion: a systematic review and meta-analysis. Medicine. 2017;96(1).
8. 8. Spiliotis J, Halkia E, Lianos E, Kalantzi N, Grivas A, Efstathiou E, et al. Cytoreductive surgery and HIPEC in recurrent epithelial ovarian cancer: a prospective randomized phase III study. Annals of surgical oncology. 2015;22(5):1570-5.

9. 9. Van Driel W, Lok C, Verwaal V, Sonke G. The role of hyperthermic intraperitoneal intraoperative chemotherapy in ovarian cancer. Current treatment options in oncology. 2015;16(4):14.
10. 10. Cowan RA, O’Cearbhaill RE, Zivanovic O, Chi DS. Current status and future prospects of hyperthermic intraoperative intraperitoneal chemotherapy (HIPEC) clinical trials in ovarian cancer. International Journal of Hyperthermia. 2017;33(5):548-53.
11. 11. Tan GHC, Shannon NB, Chia CS, Soo KC, Teo MCC. Platinum agents and mitomycin C-specific complications in cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC). International Journal of Hyperthermia. 2018;34(5):595-600.
12. 12. Liberale G, Sugarbaker PH. Sclerosing encapsulating peritonitis as a potential complication of cytoreductive surgery and HIPEC: Clinical features and results of treatment in 4 patients. Surgical oncology. 2018;27(4):657-62.
13. 13. Zajonz TS, Sander M, Padberg W, Hecker A, Hörbelt R, Koch C, et al. A case report of acute pulmonary hypertension after hyperthermic intraperitoneal chemotherapy (HIPEC) and review of the literature. Annals of Medicine and Surgery. 2018;27:26-31.
14. 14. Kim WR, Hur H, Min BS, Baik SH, Lee KY, Kim NK. Single center experience with hyperthermic intraperitoneal chemotherapy. Annals of coloproctology. 2017;33(1):16.
15. 15. Foster JM, Sleightholm R, Patel A, Shostrom V, Hall B, Neilsen B, et al. Morbidity and Mortality Rates Following Cytoreductive Surgery Combined With Hyperthermic Intraperitoneal Chemotherapy Compared With Other High-Risk Surgical Oncology Procedures. JAMA network open. 2019;2(1):e186847-e.
16. 16. Abel ML, Kokosis G, Blazer DG. Pulmonary toxicity after intraperitoneal mitomycin C: a case report of a rare complication of HIPEC. World journal of surgical oncology. 2017;15(1):49.
17. 17. McKeage MJ. New-generation platinum drugs in the treatment of cisplatin-resistant cancers. Expert opinion on investigational drugs. 2005;14(8):1033-46.
18. 18. Boisen MM, Richard SD, Holtzman MP, Edwards RP, Kelley JL, Choudry MH, et al. Hyperthermic intraperitoneal chemotherapy for epithelial ovarian cancers: is there a role? Journal of gastrointestinal oncology. 2016;7(1):10.
19. 19. Ivanov AI, Christodoulou J, Parkinson JA, Barnham KJ, Tucker A, Woodrow J, et al. Cisplatin binding sites on human albumin. Journal of Biological Chemistry. 1998;273(24):14721-30.
20. 20. Innerarity S. Hypomagnesemia in acute and chronic illness. Critical care nursing quarterly. 2000;23(2):1-19.
21. 21. Kintzel PE. Anticancer drug—induced kidney disorders. Drug safety. 2001;24(1):19-38.
22. 22. Mavichak V, Wong NL, Quamme GA, Magil AB, Sutton RA, Dirks JH. Studies on the pathogenesis of cisplatin-induced hypomagnesemia in rats. Kidney international. 1985;28(6):914-21.
23. 23. Kuhar CG, Strojan P, Zadnik V, Zakotnik B. Importance of magnesium sulfate supplementation in the prevention of hypomagnesemia and hypocalcemia during chemoradiation in head and neck cancer. Journal of Trace Elements in Medicine and Biology. 2018;50:327-31.
24. 24. Yamamoto Y, Watanabe K, Matsushita H, Tsukiyama I, Matsuura K, Wakatsuki A. The Incidence of Cisplatin-induced Hypomagnesemia in Cervical Cancer Patients Receiving Cisplatin Alone. Yakugaku zasshi: Journal of the Pharmaceutical Society of Japan. 2017;137(1):79-82.
25. 25. Hodgkinson E, Neville-Webbe H, Coleman R. Magnesium depletion in patients receiving cisplatin-based chemotherapy. Clinical oncology. 2006;18(9):710-8.
26. 26. Crook M. Hypophosphataemia and hypokalaemia in patients with hypomagnesaemia. British journal of biomedical science. 1994;51(1):24-7.
27. 27. Lajer H, Daugaard G. Cisplatin and hypomagnesemia. Cancer treatment reviews. 1999;25(1):47-58.
28. 28. Lajer H, Kristensen M, Hansen H, Nielsen S, Frøkiær J, Østergaard LF, et al. Magnesium depletion enhances cisplatin-induced nephrotoxicity. Cancer chemotherapy and pharmacology. 2005;56(5):535-42.
29. 29. Liu W, Qdaisat A, Soliman PT, Ramondetta L, Lopez G, Narayanan S, et al. Hypomagnesemia and Survival in Patients with Ovarian Cancer Who Received Chemotherapy with Carboplatin. The Oncologist. 2019.