Antineoplastics
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Reactions 891 - 2 Mar 2002 S Antineoplastics Enteritis and haemorrhagic cystitis following pelvic radiotherapy: 2 case reports Two women, who had undergone pelvic radiotherapy for gynaecological malignancies, developed complications following antineoplastic therapy for leukaemia; one of the patients developed severe enteritis, while the other developed haemorrhagic cystitis. The first woman, aged 35 years, developed colicky lower abdominal pain, dysuria and watery diarrhoea on day 16 of her second course of antineoplastic therapy comprising daunorubicin 60 mg/m 2 /day for 3 days, thioguanine 200 mg/m 2 /day for 7 days and a 7-day continuous infusion of cytarabine 200 mg/m 2 /day. A laparotomy on day 25 revealed marked transmural oedema and vascular congestion of the small bowel and colon with widespread necrosis, haemorrhage and mucosal ulceration. The woman underwent a resection of her terminal ileum, and a biopsy taken at that time revealed features consistent with neutropenic enterocolitis and chronic radiation enteritis in her small bowel and caecum. She recovered slowly from her operation. She withdrew from antineoplastic therapy, but underwent reinduction therapy approximately 12 months later for a relapse of her disease. The second woman, aged 53 years, presented with an increased frequency of micturition and marked haematuria. During the previous year, she had received induction antineoplastic therapy with vincristine 2 mg/week for 6 weeks, prednisolone 60 mg/m 2 /day for 6 weeks, daunorubicin 60 mg/m 2 /day for 4 days and intrathecal methotrexate [dosage not stated]. This was followed by 1 course of consolidation therapy with methotrexate 3 g/m 2 followed by 6 doses of cytarabine 3 g/m 2 administered every 12 hours and cyclophosphamide 1 g/m 2 with mesna. She then received 2 courses of further consolidation therapy with 4-day infusions of vincristine 1.6mg and doxorubicin 36 mg/m 2 , with dexamethasone 40 mg/day for 4 days. Maintenance therapy with mercaptopurine [dosage not stated] was then administered. Cystoscopy revealed extensive inflammation, haemorrhage and fibrosis of the woman’s bladder mucosa. She underwent urinary ileal diversion, but she subsequently died from progressive leukaemia. Author comment: ‘Although chemo- or radiotherapy alone may be responsible for such severe complications, we believe it is more likely that cytotoxic drugs caused further acute mucosal toxicity and epithelial stem cell damage to a chronically ischaemic mucosa which had been damaged by radiation.’ Macheta M, et al. Chemotherapy for leukaemia following previous pelvic radiotherapy is associated with severe enteritis and haemorrhagic cystitis. Annals of Hematology 80: 485-487, Aug 2001 - England 807207419 1 Reactions 2 Mar 2002 No. 891 0114-9954/10/0891-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved
Transcript of Antineoplastics
Reactions 891 - 2 Mar 2002
SAntineoplastics
Enteritis and haemorrhagic cystitis following pelvicradiotherapy: 2 case reports
Two women, who had undergone pelvic radiotherapy forgynaecological malignancies, developed complicationsfollowing antineoplastic therapy for leukaemia; one of thepatients developed severe enteritis, while the other developedhaemorrhagic cystitis.
The first woman, aged 35 years, developed colicky lowerabdominal pain, dysuria and watery diarrhoea on day 16 of hersecond course of antineoplastic therapy comprisingdaunorubicin 60 mg/m2/day for 3 days, thioguanine 200mg/m2/day for 7 days and a 7-day continuous infusion ofcytarabine 200 mg/m2/day. A laparotomy on day 25 revealedmarked transmural oedema and vascular congestion of thesmall bowel and colon with widespread necrosis,haemorrhage and mucosal ulceration.
The woman underwent a resection of her terminal ileum,and a biopsy taken at that time revealed features consistentwith neutropenic enterocolitis and chronic radiation enteritisin her small bowel and caecum. She recovered slowly from heroperation. She withdrew from antineoplastic therapy, butunderwent reinduction therapy approximately 12 months laterfor a relapse of her disease.
The second woman, aged 53 years, presented with anincreased frequency of micturition and marked haematuria.During the previous year, she had received inductionantineoplastic therapy with vincristine 2 mg/week for 6 weeks,prednisolone 60 mg/m2/day for 6 weeks, daunorubicin 60mg/m2/day for 4 days and intrathecal methotrexate [dosage notstated]. This was followed by 1 course of consolidation therapywith methotrexate 3 g/m2 followed by 6 doses of cytarabine 3g/m2 administered every 12 hours and cyclophosphamide 1g/m2 with mesna. She then received 2 courses of furtherconsolidation therapy with 4-day infusions of vincristine1.6mg and doxorubicin 36 mg/m2, with dexamethasone 40mg/day for 4 days. Maintenance therapy with mercaptopurine[dosage not stated] was then administered.
Cystoscopy revealed extensive inflammation, haemorrhageand fibrosis of the woman’s bladder mucosa. She underwenturinary ileal diversion, but she subsequently died fromprogressive leukaemia.
Author comment: ‘Although chemo- or radiotherapy alonemay be responsible for such severe complications, we believe itis more likely that cytotoxic drugs caused further acute mucosaltoxicity and epithelial stem cell damage to a chronicallyischaemic mucosa which had been damaged by radiation.’Macheta M, et al. Chemotherapy for leukaemia following previous pelvicradiotherapy is associated with severe enteritis and haemorrhagic cystitis. Annalsof Hematology 80: 485-487, Aug 2001 - England 807207419
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Reactions 2 Mar 2002 No. 8910114-9954/10/0891-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved
