Korean Journal of Head & Neck Oncology (대한두경부종양학회지)

The Korean Society for Head and Neck Oncology (대한두경부종양학회)
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A Case of Pharmacokinetics of Cisplatin in Concurrent Chemoradiation for Hemodialysis Patient with Advanced Head and Neck Cancer

혈액 투석을 받는 두경부암 환자의 동시화학방사선요법에서 Cisplatin의 약력학 조사 1예

  • Jeon, Youn-Joo (Departments of Internal Medicine, St. Vincent's Hospital) ;
  • Shim, Byoung-Yong (Departments of Internal Medicine, St. Vincent's Hospital) ;
  • Kim, Hyung-Wook (Departments of Internal Medicine, St. Vincent's Hospital) ;
  • Lee, Sang-Hun (Departments of Internal Medicine, St. Vincent's Hospital) ;
  • Lee, Ho-Sang (Departments of Internal Medicine, St. Vincent's Hospital) ;
  • Park, Cheol-Whee (Departments of Internal Medicine, St. Vincent's Hospital) ;
  • Kim, Su-Zy (Departments of Radiation Oncology, St. Vincent's Hospital) ;
  • Kuh, Hyo-Jeong (Catholic Research Institutes of Medical Science) ;
  • Kim, Hoon-Kyo (Departments of Internal Medicine, St. Vincent's Hospital)
  • 전연주 (가톨릭대학교 의과대학 내과학교실) ;
  • 심병용 (가톨릭대학교 의과대학 내과학교실) ;
  • 김형욱 (가톨릭대학교 의과대학 내과학교실) ;
  • 이상훈 (가톨릭대학교 의과대학 내과학교실) ;
  • 이호상 (가톨릭대학교 의과대학 내과학교실) ;
  • 박철휘 (가톨릭대학교 의과대학 내과학교실) ;
  • 김수지 (가톨릭대학교 방사선종양학과교실) ;
  • 구효정 (가톨릭대학교 의과학 연구원) ;
  • 김훈교 (가톨릭대학교 의과대학 내과학교실)
  • Published : 2007.11.30
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Abstract

Objectives : We study the feasibility and pharmacokinetics of cisplatin concurrent chemoradiation for advanced head and neck cancer patient undergoing hemodialysis. Materials and Methods : A 57-year old male with end stage renal disease developed stage III external auditory canal cancer. Complete resection surgery was done. Postoperative 6 months, local recurrence was occurred. Despite excision and adjuvant radiotherapy, local tumor was recurred. We decided to treat a cisplatin concurrent chemoradiotherapy. Cisplatin was administered at a dose of $20mg/m^2$ for 30 min. Hemodialysis was started 30 min after completion of the cisplatin infusion and performed for 4 hours. Hemodialysis was performed on day 3 and 5 of chemotherapy. Plasma samples were collected at specified times after administration of cisplatin. Result : At the end of the third cycle of cisplatin concurrent chemoradiotherapy, the tumor size was markedly decreased. The maximum plasma concentrations of plasma platinum and free platinum were 0.74 and $0.37{\mu}g/ml$ respectively. The area under the curve of plasma platinum and free platinum were 94.7 and $11.3{\mu}g{\cdot}h/ml$ respectively. Conclusion : We report a case of Cisplatin concurrent chemoradiation for hemodialysis patient with advanced head and neck cancer and suggest full dose cisplatin concurrent chemoradiotherpay is tolerable for these patients.

목적 : 투석을 받고 있는 진행된 두경부암 환자에서 Cisplatin 동시 화학방사선 요법의 타당성과 약물역동학에 대해 연구하였다. 방법 : 57세 말기 신장병을 앓고 있던 남자환자가 임상 병기 3기의 외이도 암을 진단 받고 종양 완전 절제술을 시행하였다. 수술 후 6개월에 환자는 국소 부위 재발하였다. 절단술과 술후 5200cGy, 26fx의 방사선 치료 시행에도 불구하고 다시 국소 부위 재발 보여 3주기동안 Cisplatin 기반의 방사선 화학 병합 요법 치료를 하였다. 총 3주간 Cisplatin $20mg/m^2$를 투여했으며 화학 요법 1일째 30분 동안 Cisplatin을 정주하고 30분 후 혈액투석을 4시간 동안 시행하였다. 화학요법 3일째와 5일째에도 혈액투석을 시행하였다. 환자의 혈장 시료는 Cisplatin 정주 후 특정한 시간에 채취되었다. 결과 : Cisplatin 동시 화학방사선요법 3차 시행 후 환자의 종괴 크기는 현저하게 감소하였다. Cisplatin의 최대 혈장 농도는 총 platinum은 $0.74{\mu}g/ml$였고 free platinum은 $0.37{\mu}g/ml$로 이었다. AUC 값은 총 platinum은 $94.7{\mu}g{\cdot}h/ml$, free platinum은 $11.3{\mu}g{\cdot}h/ml$이었다. 결론 : 투석을 받는 진행된 두경부암 환자에서 Cisplatin 동시 화학방사선요법을 시행한 증례를 보고하며 이들 환자에서 정용량의 Cisplatin 동시 화학방사선요법이 감내할 만하다고 제안한다.

Keywords

References

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