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Japanese Journal of Clinical Oncology 31:382-387 (2001)
© 2001 Foundation for Promotion of Cancer Research

Retrospective Study of Hyponatremia in Gastric Cancer Patients Treated with a Combination Chemotherapy of 5-Fluorouracil and Cisplatin: a Possible Warning Sign of Severe Hematological Toxicities?

Narikazu Boku, Atsushi Ohtsu, Fumio Nagashima, Manabu Muto, Tetsu Shinkai and Shigeaki Yoshida+

Division of Digestive Endoscopy and Gastrointestinal Oncology, National Cancer Center Hospital East, Kashiwa, Chiba, Japan

Background: Some anti-neoplastic agents induce hyponatremia. The relationship between hyponatremia and other toxicities in gastric cancer patients treated with 5-fluorouracil and cisplatin (FP) was investigated retrospectively to clarify its clinical significance.

Methods: The subjects were 50 advanced gastric cancer patients treated with FP. Patients’ performance status, oral intake, nausea/vomiting, diarrhea, fever, urine volume, presence of ascites or pleural effusion, laboratory data and administration of diuretics, corticosteroid and contents and volume of hydration before and during the first 5 days after chemotherapy were reviewed.

Results: The serum sodium level decreased after initiation of chemotherapy in all patients and the lowest level (nadir) was most frequently observed on day 8 (range, days 2–14), which preceded hematological toxicities. In 10 patients (20%) the nadir of serum sodium was lower than 125 mEq/l. We classified these 10 patients as a low-sodium group and the others into a normal-sodium group. Six (60%) and seven (70%) of the 10 patients in the low-sodium group had complications with grade 3 or 4 leukopenia and thrombocytopenia, whereas only one (3%) and two (5%) were seen in the normal-sodium group (p < 0.0001). Stomatitis and diarrhea were also slightly more severe in the former than the latter group. With respect to sensitivity and probability, receiver operating characteristic curves showed the nadir (>= or <125 mEq/l) of the serum sodium level was the best marker for both leukopenia and thrombocytopenia.

Conclusion: Hyponatremia after initiation of chemotherapy with FP may be a warning sign of subsequent severe hematological toxicity.

+ For reprints and all correspondence: Narikazu Boku, Division of Digestive Endoscopy and Gastrointestinal Oncology, National Cancer Center Hospital East, 6–5–1, Kashiwanoha, Kashiwa, Chiba 277-8577, Japan. E-mail: nboku@east.ncc.go.jp


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