Nadroparine activated fibrinolysis and improvement of glomerular filtration rate in patients with FIGO IIB-IIIB cervical cancer treated with radiochemotherapy

Gynecol Oncol. 2007 Jan;104(1):24-31. doi: 10.1016/j.ygyno.2006.06.041. Epub 2006 Sep 7.

Abstract

Objectives: (1) Evaluation of the influence of hemostatic disorders on renal function in patients with FIGO stage IIB-IIIB cervical cancer treated with radiochemotherapy. (2) Identifying methods of improving renal function in this patients group.

Methods: Treatment design assumes the administration of a total radiation dose of 46-65 Gy and, additionally, cisplatin 40 mg/m2 every 7 days in patients with normal plasma creatinine level. Renal function was assessed with the aid of dynamic scintigraphy with glomerular filtration rate (GFR) evaluation. Analysis of serum hemostatic system covered D-dimers, PAP, PAI-1, tPA, FDP, F1+2 and TAT. The same hemostatic parameters were also evaluated in urine. The patients were divided into two groups: the study group - i.e. patients with affected GFR and the control group - with normal GFR. Half of study group patients, throughout the entire treatment, receive nadroparine 2850 units aXa/0.3 ml every 24 h during and 6 weeks after the treatment.

Results: There are significant decreases of GFR in control (median -9.7%) and study group without nadroparine (median -9.9%) and increase in the GFR (median 22.3%) in study group with nadroparine (p=0.0001). Plasma and urine hemostatic parameter analysis showed activation of fibrinolysis in patients treated with nadroparine and fibrinolysis inhibition in remaining groups.

Conclusions: (1) Inhibition of fibrinolysis may cause subclinical renal insufficiency in patients with advanced cervical cancer. (2) Insufficiency increases after the end of radiochemotherapy in patients, as well with normal GFR as, with primary decreased GFR. (3) Application of nadroparine causes fibrinolysis activation, and increase in the GFR.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Cisplatin / therapeutic use*
  • Combined Modality Therapy
  • Female
  • Fibrinolysis / drug effects
  • Fibrinolytic Agents / therapeutic use*
  • Glomerular Filtration Rate / drug effects
  • Humans
  • Kidney / blood supply
  • Kidney / drug effects
  • Kidney Diseases / blood
  • Kidney Diseases / drug therapy*
  • Kidney Diseases / etiology*
  • Middle Aged
  • Nadroparin / therapeutic use*
  • Neoplasm Staging
  • Prospective Studies
  • Renal Circulation / drug effects
  • Uterine Cervical Neoplasms / blood*
  • Uterine Cervical Neoplasms / drug therapy
  • Uterine Cervical Neoplasms / radiotherapy
  • Uterine Cervical Neoplasms / therapy*

Substances

  • Fibrinolytic Agents
  • Nadroparin
  • Cisplatin