Publication: Risk and impact of delayed renal impairment in patients with locally advanced head and neck squamous cell carcinoma receiving chemoradiotherapy with cisplatin
Issued Date
2020-01-01
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ISSN
14337339
09414355
09414355
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2-s2.0-85086360197
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Mahidol University
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SCOPUS
Bibliographic Citation
Supportive Care in Cancer. (2020)
Suggested Citation
Thana Patimarattananan, Arkom Nongnuch, Poompis Pattaranutaporn, Nattawut Unwanatham, Chuleeporn Jiarpinitnun, Nuttapong Ngamphaiboon Risk and impact of delayed renal impairment in patients with locally advanced head and neck squamous cell carcinoma receiving chemoradiotherapy with cisplatin. Supportive Care in Cancer. (2020). doi:10.1007/s00520-020-05566-y Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/58262
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Title
Risk and impact of delayed renal impairment in patients with locally advanced head and neck squamous cell carcinoma receiving chemoradiotherapy with cisplatin
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Abstract
© 2020, Springer-Verlag GmbH Germany, part of Springer Nature. Background: An incidence of cisplatin-induced acute kidney injury (AKI) of 34% has been reported in patients with locally advanced head and neck squamous cell carcinoma (LA-HNSCC). However, delayed cisplatin-induced nephrotoxicity and long-term renal outcomes remain poorly studied. Methods: Patients with LA-HNSCC who underwent definitive or postoperative cisplatin-based chemoradiotherapy (CRT) were included. Acute kidney disease (AKD) was defined as newly developed estimated glomerular filtration rate (eGFR) < 60 ml/min/1.73 m2 for < 3 months, ≥ 35% decrease in eGFR, or > 50% increase in serum creatinine for <3 months from baseline. Results: A total of 509 patients were analyzed. AKD and AKI occurred in 27.9% and 13.4% of patients, respectively. Most patients had primary prophylactic feeding tube (95%) and definitive CRT (83%). More AKD patients had an ECOG status of 0 (p = 0.017), diabetes (p = 0.044), and hypertension (p < 0.001). AKI, but not AKD, was significantly associated with cumulative cisplatin dose, delay, dose reduction, termination, and hospitalization during CRT. GFR percentage in patients with AKD declined significantly during CRT (− 36%), worsened at 3 months (− 39%), and had not recovered to baseline at 12 months after CRT (− 29%). Multivariate analysis identified ECOG status 0 and hypertension as significantly associated with the development of AKD. Conclusion: Almost one third of LA-HNSCC patients who underwent CRT with cisplatin developed AKD, and their eGFR did not recover to baseline even after 1 year. ECOG 0 and hypertension were associated with AKD. These findings may have been due to the physician’s awareness of AKD and underestimation of its potential complications in fit patients.