Renal function related to different treatment modalities for malignant germ cell tumours

Abstract

Summary The renal function was evaluated with '3'I-Hippuran clearance in 171 patients with malignant germ cell tumours. Assessments were performed before treatment and at three fixed times afterwards within 5 years. The patients were treated with surgery only (20 patients), infra-diaphragmatic radiotherapy only (median midplane dose 36 Gy) (48 patients), cisplatin-based chemotherapy (total cisplatin dose 500-850 mg) plus surgery (64 patients), cisplatin-based chemotherapy (total cisplatin dose> 850 mg) with or without surgery (23 patients) or cisplatin-based chemotherapy (total cisplatin dose 500-850mg) plus infra-diaphragmatic radiotherapy (16 patients). No renal impairment was observed for patients treated with surgery only. In patients who received radiotherapy no change of the renal function occurred during the first year post-treatment. Three to five years after treatment discontinuation a statistically significant reduction within the normal range was observed in patients who were >40 years at the time of irradiation. Cisplatin-based chemotherapy led to a statistically significant irreversible renal impairment for all the three groups. The greatest reduction was seen in patients who received the highest total cisplatin dose or who were treated with irradiation in addition to chemotherapy. The clinical significance of the observed nephrotoxicity is still unknown.There is a lack of comparative studies regarding nephrotoxicity after different treatment modalities for testicular cancer. Renal toxicity is a well-known side effect after cisplatin-based combination chemotherapy (Dentino et al., 1978;Offerman et al., 1984;Safirstein et al., 1986), but less attention has been paid to the possible renal impairment after high-voltage abdominal radiotherapy and the combination of chemotherapy and irradiation.The aim of the present prospective study was to evaluate the renal function after retroperitoneal lymph node dissection, cisplatin-based chemotherapy, abdominal radiotherapy, and after combined treatment with chemotherapy and irradiation. Both the acute and the long-term results were assessed. Patients and methodsA total of 171 patients with malignant germ cell tumours (testicular 162, extragonadal nine) were included in the study (Table I). These patients represented a consecutive series of patients treated at The Norwegian Radium Hospital during two periods

Clinical and Biochemical Long–Term Toxicity after Postoperative Cisplatin–Based Chemotherapy in Patients with Low-Stage Testicular Cancer

“…However, in Hansen and Olsen's [26] series the postchemotherapy Mg values remained within the normal range, as was the case in the present series. Low Mg levels indicate a slight damage of the renal tubuli, supporting previous observations of long-lasting decreased kidney function in patients who have received cisplatin-based chemotherapy [11,12,24], Hypomagnesia has also been associated with Raynaud-like phenome na [24] and -more infrequently -with cardiovascular dis orders (see below).…”

Vascular Complications of Cancer Chemotherapy

“…Nephrotoxicity is a well documented adverse effect of cisplatin use, with a dose-dependent and irreversible reduction in renal function. 75 , 76 , 77 Possible mechanisms include endothelial and epithelial cell damage and dysfunction. 78 Patients treated with cisplatin-based chemotherapy have a high prevalence of microalbuminuria 62 , 66 and there are indications to suggest that patients who develop microalbuminuria in association with cisplatin-based chemotherapy have higher blood pressure levels than those who do not.…”

Pre- and post-treatment sexual life in testicular cancer patients: a descriptive investigation

“…Patients treated with all modalities were included. The treatment principles have been outlined elsewhere (Aass et al, 1990). Thirteen patients underwent unilateral retroperitoneal lymph node dissection (RLND) as their only treatment after orchiectomy.…”