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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

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.

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Funding

This study was funded by the Thailand Grand Challenge Program for Research University Network (RUN) under the Precision Medicine for Cancer project by the National Research Council of Thailand. N. Ngamphaiboon received funding from the RUN, the Thailand Research Fund, and a Research Development Grant from Ramathibodi Hospital.

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Authors and Affiliations

  1. Division of Medical Oncology, Department of Medicine, Ramathibodi Hospital, Faculty of Medicine, Mahidol University, Bangkok, Thailand

    Thana Patimarattananan & Nuttapong Ngamphaiboon

  2. Division of Nephrology, Department of Medicine, Ramathibodi Hospital, Faculty of Medicine, Mahidol University, Bangkok, Thailand

    Arkom Nongnuch

  3. Division of Radiation Oncology, Department of Radiology, Ramathibodi Hospital, Faculty of Medicine, Mahidol University, Bangkok, Thailand

    Poompis Pattaranutaporn & Chuleeporn Jiarpinitnun

  4. Section for Clinical Epidemiology and Biostatistics, Ramathibodi Hospital, Faculty of Medicine, Mahidol University, Bangkok, Thailand

    Nattawut Unwanatham

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  1. Thana Patimarattananan
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Correspondence to Nuttapong Ngamphaiboon.

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Patimarattananan, T., Nongnuch, A., Pattaranutaporn, P. et al. Risk and impact of delayed renal impairment in patients with locally advanced head and neck squamous cell carcinoma receiving chemoradiotherapy with cisplatin. Support Care Cancer 29, 877–887 (2021). https://doi.org/10.1007/s00520-020-05566-y

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  • DOI: https://doi.org/10.1007/s00520-020-05566-y

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