Increased Pulmonary Toxicity with Bleomycin and Cisplatin Chemotherapy Combinations
Increased Pulmonary Toxicity with Bleomycin and Cisplatin Chemotherapy Combinations
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DOI：
10.1097/00000421-199004000-00009
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发表时间：
1990-04
期刊：
影响因子：
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通讯作者：
Milton Rabinowits;L. Souhami;R. Gil;C. Andrade;H. Paiva
中科院分区：
文献类型：
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作者：
Milton Rabinowits;L. Souhami;R. Gil;C. Andrade;H. Paiva
45例可评估患者（30例宫颈癌患者，15例生殖细胞肿瘤患者）采用博来霉素和顺铂联合化疗。顺铂输注后给予博来霉素，生殖细胞肿瘤患者静脉连续输注72 h，宫颈癌患者每12 h肌注一次，连续4天。博来霉素的总剂量从156到360 u不等，9例在化疗前肾功能正常且无肺部疾病的患者出现了严重的肺毒性。6名患者死于不可逆转的呼吸衰竭。对所有6名患者进行了死后肺研究，结果与博莱霉素引起的肺毒性一致。肾小管损伤见于四个可检查的肾脏。化疗后血清肌酐升高的7例患者中有5例（71.5%）出现肺损伤，而血清肌酐水平未发生变化的患者中有10.5%出现肺损伤（p = 0.001）。顺铂给药后的肾脏损害以及随后博来霉素的积累可能是高肺毒性的原因。建议慎用博莱霉素-顺铂联合化疗。只要可能，博来霉素应先于顺铂输注，以尽量减少肺毒性的风险。
Combination chemotherapy that included bleomycin and cisplatin was administered to 45 evaluable patients (30 with cervic carcinoma and 15 with germ cell tumors). Bleomycin was given, following cisplatin infusion, either by intravenous continuous infusion over 72 h (germ cell tumor patients) or intramuscularly every 12 h for 4 days (cervix carcinoma patients). Total bleomycin doses ranged from 156 to 360 U. Nine patients with normal renal function and no previous pulmonary disease prior to chemotherapy developed serious pulmonary toxicity. Six patients died from irreversible respiratory failure. Postmortem lung studies were performed in all six patients and revealed findings compatible with bleomycin-induced lung toxicity. Renal tubular damage was found in four kidneys available for examination. Five (71.5%) of the seven patients whose serum creatinine increased after chemotherapy was initiated developed lung injury, whereas 10.5% of those without change in the serum creatinine level presented this complication (p = 0.001). Renal damage, following cisplatin administration, with subsequent accumulation of bleomycin was the likely cause of the high lung toxicity. Extreme caution is recommended in the administration of combined bleomycin-cisplatin chemotherapy. Whenever possible, bleomycin should precede cisplatin infusion to minimize the risk of lung toxicity.