CİSPLATİN UYGULANAN AKCİĞER CA'LI HASTALARDA SERUM MAGNEZYUM VE KALSİYUM DÜZEYLERİNİN MONİTERİZASYONU GEREKLİ MİDİR?

Yıl 2004, Cilt: 18 Sayı: 3, 101 - 106, 01.12.2004

Berna Kömürcüoğlu Melih Büyükşirin Hür İşgüder Dilek Kalenci Emel Özden

Öz

Platin türevi bir antineoplastik ajan olan Cisplatin (Cis), böbrek tübüler sistemine toksik etkisiyle idrarla magnezyum (Mg) kaybına yol açarak hipomagnezemiye ve hipokalsemiye neden olabilir. Çalışmamızda mitomisin-ifosfamid-cisplatin (MİC) kemoterapi tedavisi alan 35 ileri evre akciğer maligniteli hastada, takip eden 3 kemoterapi (KT) siklusunda tedavi öncesi ve sonrası serum Mg (magnesyum) ve Ca (kalsiyum) düzeyleri çalışıldı. Hipomagnesemi ve hipokalsemiye ait klinik semptomlar sorgulandı. Olgularda KT'ye bağlı, ilk dozda ve kümülatif dozlarda hipomagnesemi ve hipokalsemi sıklığı ve klinik bulguları araştırıldı. Olguların kemoterapi öncesi serum Mg ort. 2.4 ± 0.37 (1.8-2.9), sonrası Mg ort. 2.2 ± 0.33 (1.5-2.7) idi.

Anahtar Kelimeler

Cisplatin, akciğer ca , magnesyum, kalsiyum

IS IT NECESSARY TO EVALUATE THE MAGNESIUM AND CALCIUM LEVELS IN CISPLATINUM TREATED LUNG CANCER PATIENTS?

Öz

Cisplatinum, an antineoplastic agent derived from platinum, induces hypomagnesemia and hypocalcemia through its renal toxicity by losing magnesium (Mg) with ürine. We have evaluated serum levels of magnesium (Mg) and calcium (Ca) in 35 cases with advanced lung cancer before and after MIC chemotherapy during three cycles. Clinical symptoms associated with hypomagnesemia and hypocalcemia were examined. Clinical findings associated with chemotherapy in the first dose and cumulated doses were evaluate. Serum Mg levels before chemotherapy was found as 2.4 ± 0.37 (1.8-2.9) and after chemotherapy 2.2 ± 0.33 (1.5-2.7). A significant decrease in serum magnesium level after chemotherapy was observed whereas there was no significant change in serum Ca levels. There was no major clinical finding associated with hypomagnesemia and hypocalcemia, but in only 6 patients (%17.2) mild hypoaesthesia and paresthesia were seen. There was no significant changes in Mg and Ca levels between the cycles throughout three chemoterapy cycles. In concl usion although significant decrease in serum Mg levels of patients having MIC therapy was observed with no any clinical sign. Hypocalcemia was a rare finding and can be seen in only cases with serious hypomagnesemia. Three cycles of chemotherapy havenÕt caused any serious cumulative changes in Mg and Ca levels in a short period of time.

Anahtar Kelimeler

Cisplatinum, lung ca, magnesium, calcium

Kaynakça

• Nicholas J, Vogelzang NJ, Torkelson JL, Kennedy BJ. Hypomagnesemia, renal dysfunction, and Raynould’s Phenomenon in patients with cisplatin, Vinblastine, and Bleo- mycin. Cancer 1985; 56: 2765-70.
• Agus ZS, Wasserstein A, Godfarb S. Disorders of calcium and magnesium homeostasis. Am J Med 1982; 72: 473-84.
• Hutchinson FN, Perez EA, Gandara DR, Lawrance HJ. Renal salt wasting in patients treated with cisplatin. Ann Intern Med 108: 5. Peyrade F, Taillan B, Lebrun C, et al. Hypo- natremia during treatment with cisplatin. Presse Med 1997; 32: 1523-5.
• Tweigeri T, Magliocco A, DeCoteau J. Cortical blindness as a manifestation of hypomagne- semia secondary to cisplatin therapy. Gynecol Oncol 1999; 72: 120-2.
• Lajer H, Daugaard G. Cisplatin and hypomag- nesemia. Cancer Treat Rev 1999; 25: 47-58.
• Ariceta G, Soriano J, Vallo A, et al. Acute and chronic effects of Cisplatin therapy on renal magnesium homeostasis. Med Pediatr Oncol 1997; 28: 35-40.
• Vokes EE, Panje WR, Mick R, Kozloff MF. A randomise study comparing two regimens of neoadjuvant and adjuvant chemotherapy in multimodal therapy for locally advanced head and neck cancer. Cancer 1990; 66: 206-13.
• Buckley JE, Clark VL, Meyer TJ, pearlman NW. Hypomagnesemia after cisplatin combination chemotherapy. Arch Intern Med 1984; 144: 8.
• Schilsky Rl, Anderson T. Hypomagnesemia and renal magnesium wasting in patients receving cisplatin. Ann Int Med 1989; 90: 31.
• Ece F, Kula N, Sivaslıoğlu S, Sanioğlu B. Cisplatine içeren kemoterapi kombinasyonu uygulanan akciğer Ca’lı olgularda rutin intra- venöz magnesyum tedavisinin gerekliliği. Solunum 1993; 18: 530-8.
• Stewart AF, Keating T, Scwarta PE. Magne- sium homeostasis following chemotherapy with cisplatin: a prospective study. Am J Obstet Gynecol 1985; Nov (15): 660-5.
• Bıtran JD, Desser RK, Billings AA, Kozloff MF et al. Acute nephrotoxicity following cispla- tinum. Cancer 1982; 49: 1784-88.
• Brousse C, Baumelou E, Mignot L. Hypo- calcemia caused by hypomagnesemia during a treatment with cisplatin. Rev Med Interne ; 17(6): 498. Planting A, Catimel G, Mulder P, et al. Randomized study of a short course of weekly cisplatin with or without amifostine in advanced head and neck cancer. Annals of Oncology 1999; 10: 693-700.
• Klukowska L, Nadulska A, Dyba S. The influence of cisplatinum and goserlinum on the magnesium and calcium level in serum. Ann Univ Mariae Curie Sklodowska 2001; : 483-6.
• Hartman J, Fels L, Knop S, et al. A rando- mized trial comparing the nephrotoxicity of cisplatin/ifosfamide-based combination che- motherapy with or without amifostine in patients with solid tumors. İnvestigational New Drugs 2000; 18: 281-289. Yazıflma Adresi:
• Dr. Berna KÖMÜRCÜO⁄LU İzmir Göğüs Hastalıkları ve Cerrahisi Eğitim ve Arafltırma Hastanesi Yeniflehir / İZMİR Tel : [phone] / 236 E-mail: [e-mail]