33 2 CISPLATIN-INDUCED ACUTE KIDNEY INJURY | PART ONE Background Three-weekly high-dose cisplatin (100 mg/m2) is considered the standard systemic regimen given concurrently with postoperative or definitive radiotherapy in locally advanced squamous cell carcinoma of the head and neck (LA-SCCHN) [1-3]. The additional absolute benefit in overall survival of adding cisplatin chemotherapy has been best estimated as 6.5% at five years when compared with radiotherapy alone [4]. However, concurrent highdose cisplatin is associated with significant acute and late toxicities [5,6]. Acute kidney injury (AKI) is a common and serious side effect of high-dose cisplatin-based concurrent chemoradiation (CRT). AKI is a predictor of immediate and long-term adverse outcomes. Even a minor acute reduction in kidney function has an adverse prognosis [7]. The incidence of cisplatin-induced AKI has been reported before [5, 8-10]. However, development of AKI during high-dose cisplatin-based CRT is underreported, using the Kidney Disease Improving Global Outcomes (KDIGO) criteria [11], which are the most recent and preferred criteria for diagnosis and staging of AKI. Also, little is known about the impact of AKI on long-term renal function and treatment outcomes in patients with LA-SCCHN. Early detection of AKI enables early intervention, which might lessen treatment burden and improves efficacy and cost-effectiveness of care [12]. Therefore, it is clinically relevant to identify potentially modifiable risk factors for cisplatin-induced AKI in this patient group. The purpose of this study is to answer the following questions: (1) what is the incidence of AKI during treatmentwithhigh-dose cisplatin-basedCRT for LA-SCCHN, according toKDIGO criteria, (2) which predictors for development of cisplatin-induced AKI can be identified, and (3) what are the long-termconsequences of cisplatin-inducedAKI in this patient group? Methods Study design From January 2017 to July 2017, patient data were collected retrospectively by two investigators (M.V. and E.N.) from electronic medical records (EMRs) between January 2011 (introduction of EMRs in our center) and January 2014. Patient population Patients, both female and male, 18 years or older, with histologically proven, resectable high-risk or not-resectable LA-SCCHN, who were treated with three-weekly high-dose (100 mg/m2) cisplatin-based CRT from January 2011 to January 2014 at the Amsterdam University Medical Center, VU University, were included in this study. Exclusion criteria were a history of AKI or a creatinine clearance of ≤60 mL/min/1.73 m2 (estimated by the Cockcroft-Gault equation) before start of CRT. Other exclusion criteria were diagnosis of nasopharyngeal carcinoma, previous treatment with radiotherapy and/or chemotherapy, and treatment with biologicals. This retrospective study was not subject to the Dutch Medical Research Involving Human Subjects (WMO) act as was determined by theMedical Ethics Committee of the Amsterdam UMC, Vrije Universiteit Amsterdam.
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