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J Surg Oncol. 2019 Dec;120(7):1220-1226. doi: 10.1002/jso.25726. Epub 2019 Oct 10.

Adequate nephroprotection reduces renal complications after hyperthermic intrathoracic chemotherapy.

Author information

1
Department of Thoracic Surgery, University Medical Center Regensburg, Regensburg, Germany.
2
Department of Thoracic Surgery, Hospital Barmherzige Brüder Regensburg, Regensburg, Germany.
3
Center for Clinical Studies, University Medical Center Regensburg, Regensburg, Germany.

Abstract

BACKGROUND AND OBJECTIVES:

Hyperthermic intrathoracic chemotherapy (HITOC) is used for the treatment of malignant pleural tumors. Although HITOC proved to be safe, postoperative renal failure due to nephrotoxicity of intrapleural cisplatin remains a concern.

METHODS:

This single-center study was performed retrospectively in patients who underwent pleural tumor resection and HITOC between September 2008 and December 2018.

RESULTS:

A total of 84 patients (female n = 33; 39.3%) with malignant pleural tumors underwent surgical cytoreduction with subsequent HITOC (60 minutes; 42°C). During the study period, we gradually increased the dosage of cisplatin (100-150 mg/m2 BSA n = 36; 175 mg/m2 BSA n = 2) and finally added doxorubicin (cisplatin 175 mg/m2 BSA/doxorubicin 65 mg; n = 46). All patients had perioperative fluid balancing. The last 54 (64.3%) patients also received perioperative cytoprotection. Overall 29 patients (34.5%) experienced renal insufficiency. Despite higher cisplatin concentrations, patients with cytoprotection showed significantly lower postoperative serum creatinine levels after 1 week (P = .006) and at discharge (P = .020). Also, they showed less intermediate and severe renal insufficiencies (5.6% vs 13.3%).

CONCLUSIONS:

Adequate perioperative fluid management and cytoprotection seem to be effective in protecting renal function. This allows the administration of higher intracavitary cisplatin doses without raising the rate of renal insufficiencies.

KEYWORDS:

cytoprotection; hyperthermic intrathoracic chemotherapy; nephroprotection; renal insufficiency

PMID:
31602673
DOI:
10.1002/jso.25726
[Indexed for MEDLINE]

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