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Cancers 2016, 8(2), 21; doi:10.3390/cancers8020021

Nephrotoxicity as a Dose-Limiting Factor in a High-Dose Cisplatin-Based Chemoradiotherapy Regimen for Head and Neck Carcinomas

1
Department of Head and Neck Surgery and Oncology, Netherlands Cancer Institute, 1066 CX Amsterdam, The Netherlands
2
Department of Otolaryngology and Head & Neck Surgery, Leiden University Medical Center, 2300 RC Leiden, The Netherlands
3
Department of Radiotherapy, Netherlands Cancer Institute, 1066 CX Amsterdam, The Netherlands
4
Department of Biometrics, Netherlands Cancer Institute, 1066 CX Amsterdam, The Netherlands
5
Department of Medical Oncology, Netherlands Cancer Institute, 1066 CX Amsterdam, The Netherlands
These authors contributed equally to this work.
*
Author to whom correspondence should be addressed.
Academic Editor: Dirk Rades
Received: 26 November 2015 / Revised: 18 January 2016 / Accepted: 3 February 2016 / Published: 16 February 2016
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Abstract

Purpose: Loco-regional control and organ preservation are significantly improved with concomitant cisplatin/radiotherapy and are compromised with less than 5% grade 3 nephrotoxicity (creatinine clearance 15–29 mL/min). However, although clinically important, in none of the randomized trials is grade 2 nephrotoxicity (defined as creatinine clearance 59–30 mL/min) mentioned. In this study, we assessed nephrotoxicity in daily practice among patients treated with high-dose cisplatin (100 mg/m2 on days 1, 22, and 43), concurrently with chemoradiotherapy (CCRT) and the impact on treatment modifications. Methods: 208 patients with advanced-stage malignancies of the head and neck region were evaluated. All patients were treated with high-dose cisplatin CCRT. The main outcome parameters were nephrotoxicity (defined as creatinine clearance grade 2 or more) and cumulative doses of cisplatin and radiation. Results: 133 patients (64%) completed all pre-planned courses of cisplatin. Nephrotoxicity was the main reason to discontinue the chemotherapy. Grade 3 nephrotoxicity was seen in 16 patients (8%) while grade 2 nephrotoxicity was seen in 53 patients (25%). Thirty six patients (17%) could not complete the pre-planned chemotherapy due to nephrotoxicity. Conclusions: In head and neck cancer patients, nephrotoxicity grade 2 is under-reported but is the major factor for discontinuing cisplatin during CCRT. View Full-Text
Keywords: head and neck cancer; nephrotoxicity; chemoradiotherapy; cisplatin head and neck cancer; nephrotoxicity; chemoradiotherapy; cisplatin
This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. (CC BY 4.0).

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MDPI and ACS Style

Hoek, J.; Bloemendal, K.M.; van der Velden, L.-A.A.; van Diessen, J.N.; van Werkhoven, E.; Klop, W.M.; Tesselaar, M.E. Nephrotoxicity as a Dose-Limiting Factor in a High-Dose Cisplatin-Based Chemoradiotherapy Regimen for Head and Neck Carcinomas. Cancers 2016, 8, 21.

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