Concurrent weekly cisplatin chemotherapy and radiotherapy in a haemodialysis patient with locally advanced cervix cancer

Aims: Concurrent cisplatin chemo-radiotherapy improves outcome in cervical carcinoma. In haemodialysis patients, cisplatin is potentially hazardous. We report the treatment of a haemodialysis patient with cervix cancer using cisplatinbased chemo-radiation. Mathematical modelling using toxicity data from a range of cisplatin dosages and schedules reported in published studies was undertaken. Materials and methods: The patient was treated using weekly cisplatin chemotherapy 25 mg/m(2). The serum platinum levels were measured. Correlations between reported toxicity and platinum levels for a variety of cisplatin schedules in published studies were evaluated. Results: Treatment was completed with no interruptions and minimum acute toxicity. The platinum levels rose progressively. The elimination half-life was prolonged at 6.6-7.5 days. The percentage extraction varied between 7.7 and 41.0%. The cumulative cisplatin dose correlated with neurotoxicity (P = 0.002). Myelotoxicity correlated with the peak cisplatin level in the first 15 days of treatment (P = 0.01). With an elimination half-life of 7.5 days, 35 mg/m(2) weekly is predicted to have the same risk of myelotoxicity and neurotoxicity as 40 mg/m(2) weekly in a patient with normal renal function. Conclusions: Weekly cisplatin chemotherapy 25 mg/m(2) can be delivered safely in a haemodiaiysis patient. Dialysis is effective in eliminating platinum even if carried out more than 3 h after infusion, but it should commence as soon as possible after cisplatin infusion, as the incidence of myelotoxicity is related to the peak platinum level.