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. 2023 Nov:146:106579.
doi: 10.1016/j.oraloncology.2023.106579. Epub 2023 Sep 29.

Pre-treatment risk factors to predict early cisplatin-related nephrotoxicity in locally advanced head and neck cancer patients treated with chemoradiation: A single Institution experience

Stefano Cavalieri  1 , Francesca Platini  2 , Francesco Barretta  3 , Imperia Nuzzolese  2 , Arianna Ottini  2 , Cristiana Bergamini  2 , Carlo Resteghini  2 , Elena Colombo  2 , Nicola Alessandro Iacovelli  4 , Marzia Franceschini  4 , Giuseppina Calareso  5 , Patricia Di Pede  6 , Giulia De Feo  6 , Monica Gandelli  6 , Luisa Toffolatti  6 , Mauro Guglielmo  6 , Carla Ida Ripamonti  7 , Laura Cosmai  8 , Lisa Licitra  9 , Salvatore Alfieri  2
Affiliations

Pre-treatment risk factors to predict early cisplatin-related nephrotoxicity in locally advanced head and neck cancer patients treated with chemoradiation: A single Institution experience

Stefano Cavalieri et al. Oral Oncol. 2023 Nov.

Abstract

Objectives: Cisplatin is essential in the curative treatment of locally advanced head and neck squamous cell carcinoma (LA-HNSCC) patients. The assessment of risk factors to predict an early cisplatin-induced nephrotoxicity could help in better managing one of the most relevant cisplatin-related dose-limiting factors.

Material and methods: We retrospectively collected data of LA-HNSCC patients treated at our Institution from 2008 to 2019. Patients received cisplatin in a curative setting concurrently with radiation. Acute Kidney Injury (AKI) was assessed as a dichotomous variable (CreaIncr) based on pre-treatment values, and values recorded at days 6-20 post-first cycle of cisplatin. Univariable logistic regression models were performed to investigate associations between CreaIncr and clinical characteristics. A multivariable logistic model on a priori selected putative covariates was performed.

Results: Of the 350 LA-HNSCC treated patients, 204 were analyzed. Ninety (44 %) suffered from any grade AKI (grade I 51.1 %): out of them, 84.4 % received high-dose cisplatin (100 mg/m2 q21). On the univariable logistic regression model, male sex, age, serum uric acid, creatinine, concomitant drugs, and cisplatin schedule were significantly associated with a higher rate of AKI. At multivariable model, age (p = 0.034), baseline creatinine (p = 0.027), concomitant drugs (p = 0.043), and cisplatin schedule (one-day bolus or fractionated high-dose vs. weekly; p = 0.001) maintained their significant association.

Conclusions: Identifying pre-treatment risk factors in LA-HNSCC patients may improve decision-making in a setting where cisplatin has a curative significance. A strict monitoring of AKI could avoid cisplatin dose adjustments, interruptions, and treatment delays, thus limiting a negative impact on outcomes.

Keywords: Acute kidney injury; CDDP; Chemoradiation; Cisplatin; Head and neck cancer; Nephrotoxicity; Pre-treatment; Risk factors.

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Conflict of interest statement

Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

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