Palliative percutaneous nephrostomy in 26 patients with recurrent cervical cancer

Abstract

8235 Background: Cervical cancer (CC) is a public health problem in Brazil, with annual incidence rates of 20 to 40 cases/ 100.000 women. Most patients with recurrent disease have local symptoms and develop renal failure. There are no clear guidelines to predict which patients in palliative care should benefit from percutaneous nephrostomy (PN) in terms of survival and quality of life. This study aims to evaluate the outcome of patients with recurrent CC in palliative care submitted to PN and thereby identify those who can potentially benefit from this intervention. Methods: Retrospective study of 26 patients assisted in the Palliative Care Unit of INCA from January 2002 to June 2004. Results: Median age was 44 years (28 - 67). All patients were previously treated with radiotherapy with or without chemotherapy and brachytherapy. At relapse, all patients presented with locally advanced disease and 3 had metastatic disease. PN was unilateral in all patients. Sixteen patients (61%) had improvement of uremic symptoms after PN and 6 (23%) in Performance Status (PS). Median creatinine levels before and after PN were 7 and 3 mg/dl, respectively. Normalization of renal function was achieved in 10 patients (38%). Until December 2004, 24 patients have died. Median survival after PN was 61 days (95% CI: 44 - 78). Median survival was 82 days (64 - 100) in 16 patients with PS 1 - 3 and 16 days (5 - 27) in 10 patients with PS 4 (log rank p < 0.0001). Survival in patients with creatinine prior to PN lower and higher than 7 mg/dl (n: 14/12) was 74 days (48 - 100) and 48 days (0 - 106), respectively (p 0.06). In patients with creatinine after PN lower and higher than 3 mg/dl (n: 13/13) median survival was 74 days (58 - 90) and 20 days (0 - 69), respectively (p 0.02). Sixteen patients (61%) died due to renal failure, 6 (23%) from urinary sepsis and 4 (16%) from cachexia. Half of the patients had complications of PN, mainly urinary tract infection (n: 6), catheter loss (n: 6) and bleeding (n: 1). Conclusions: These data suggest that PN can be of clinical benefit for patients with recurrent CC and PS 1 to 3, offering them a chance of prolonged palliation. Improvement of renal function after PN leads to increase in survival. Complications of this procedure are frequent and most patients die in renal failure. No significant financial relationships to disclose.