We report for the first time the possibility of weekly paclitaxel chemotherapy for a patient with advanced, nonresectable gastric cancer undergoing hemodialysis. A 50-year-old man with chronic renal failure due to bilateral polycystic kidneys, who had undergone hemodialysis three times a week for 5 years, presented with hematemesis in December 2004. Based on the diagnosis of gastric cancer with lymph node metastases, surgery was performed. On the 15th postoperative day, the patient was treated with chemotherapy using paclitaxel. Paclitaxel was administered at a dose of 60 mg/m2 as a 1 h iv infusion in 250 mL of saline. Hemodialysis was started 1 h after the completion of the paclitaxel infusion and was performed for 3 h. Paclitaxel was administered weekly on d 1, 8, and 15 on a 28-d cycle. The maximum plasma concentration of paclitaxel was 1390 microg/L. The area under the curve of paclitaxel was 4398.6 microg x h/L. Grade 2 leukopenia was encountered during the first cycle. The plasma concentrations of paclitaxel from 6 to over 24 h after the infusion were 0.01 to 0.1 micromol/L in our patient, and these concentrations have been shown to be effective on inhibiting the growth of gastric cancer cells without producing adverse side effects in the patient. The plasma concentration of paclitaxel was not influenced by hemodialysis. We conclude that the pharmacokinetics of paclitaxel is not altered in a patient with renal failure, and that weekly paclitaxel is a suitable treatment regimen for hemodialysis patients with advanced gastric cancer.

译文

:我们首次报告了接受血液透析的晚期,不可切除胃癌患者每周紫杉醇化疗的可能性。一名因双侧多囊肾而导致慢性肾功能衰竭的50岁男子于5周内每周进行了3次血液透析,并于2004年12月发生了呕血。根据诊断为具有淋巴结转移的胃癌,我们进行了手术。执行。术后第15天,使用紫杉醇对患者进行化疗。紫杉醇以60 mg / m2的剂量在250 mL盐水中静脉滴注1 h。紫杉醇输注完成后1 h开始进行血液透析,并进行3 h。紫杉醇在第28天的第1、8和15天每周给药一次。紫杉醇的最大血浆浓度为1390 microg / L。紫杉醇曲线下的面积为4398.6微克×h / L。在第一个周期中遇到了2级白细胞减少症。输注后6至24小时内紫杉醇的血浆浓度在我们的患者中为0.01至0.1 micromol / L,并且这些浓度已被证明可有效抑制胃癌细胞的生长而不会对患者产生不良副作用。紫杉醇的血浆浓度不受血液透析的影响。我们得出的结论是,紫杉醇在肾衰竭患者中的​​药代动力学没有改变,并且每周紫杉醇是晚期胃癌血液透析患者的合适治疗方案。

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