Retrospectively nephrotoxicity evaluation on the head and neck cancer patients treated with high-dose cisplatin chemotherapy

Full text: Introduction: Head and neck cancer (HNC) is diagnosed at a locally advanced stage in 60% of cases. When surgery is not feasible, a combination of high-dose cisplatin (CDDP) chemotherapy and radiotherapy is the standard care. However, the overall prevalence of nephrotoxicity approaches one-third of cases and it can negatively impact the effectiveness of treatment by discontinuing it. Objective: Assess the need to create and incorporate a protocol that can systematize the prevention and management of cisplatin-induced nephrotoxicity on HNC patients. Methods: The project was approved by the local IRB. Data for demography, comorbidities, toxicity, and treatment outcome was retrospectively collected using medical records from patients with a histopathological diagnosis of HNC treated with high-dose CDDP (≥100 mg/m2). Data were collected for patients between 2015 and 2019. Results: 40 patients had data collected for analysis. The median age was 53 years, predominantly male (95%), white (75%), and KPS of 90-100 (70%). Most of the patients were smokers (52.8%) and 45% have an alcohol abuse history. Diabetes (27.8%) and Systemic Hypertension (27.8%) were the most common comorbidities, and 50% had a normal BMI at the time of diagnosis, but 20% presented malnutrition before starting chemotherapy. Treatment was interrupted for nephrotoxicity in 33% of the cases: 85% had increased creatinine. Regarding protective factors, most had access to the odontology team (97.5%), speech therapy (87.5%), nutrition (82.5%), social assistance (65%), psychology (60%) and occupational therapy (55%), 60% had prophylactic laser therapy and 75% used gastroenteric tubes. Regarding risk factors, 27.5% underwent contrast enhanced scan within 15 days of the administration of CDDP, serum albumin was measured in only 20% of patients, making it difficult to accurately estimate the nutritional profile, 17.5% used nonsteroidal anti-inflammatory drugs and weight loss at diagnosis occurred more significantly (>10%) in 30% of patients. Conclusion: This study provides descriptive information that suggests the need for the incorporation of a nephrotoxicity prevention protocol, which may improve HNC treatment. (author)