title: Renal function after ifosfamide, carboplatin and etoposide (ICE) chemotherapy, nephrectomy and radiotherapy in children with Wilms tumour.
abstract: We prospectively evaluated tumour response and renal function in 12 newly diagnosed children with high-risk Wilms tumour receiving ifosfamide, carboplatin and etoposide (ICE) chemotherapy. Two cycles of ICE were followed by 5 weeks of vincristine, dactinomycin and doxorubicin (Adriamycin) (VDA), and nephrectomy, radiotherapy, additional VDA, and a third ICE cycle. Carboplatin dosage was based on glomerular filtration rate (GFR) to achieve targeted systemic exposure (6mg/ml min). Mean GFR (measured by technetium 99m-DTPA clearance) declined by 7% after 2 cycles of ICE and by 38% after nephrectomy; the mean carboplatin dose was reduced 32% after nephrectomy. Mean GFR remained stable after the third ICE cycle. Although urinary beta(2)-microglobulin excretion increased during therapy, no patient had clinically significant renal tubular dysfunction at the end of treatment. Treatment with ICE, nephrectomy and radiotherapy significantly reduces GFR, largely as the result of nephrectomy. Adjustment of carboplatin dosage on the basis of GFR and careful monitoring of renal function may alleviate nephrotoxicity.
authors.affiliation: Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN 38105-3678, USA. najat.daw@stjude.org
authors.forename: Najat C
authors.initials: NC
authors.lastname: Daw
authors.forename: David
authors.initials: D
authors.lastname: Gregornik
authors.forename: John
authors.initials: J
authors.lastname: Rodman
authors.forename: Neyssa
authors.initials: N
authors.lastname: Marina
authors.forename: Jianrong
authors.initials: J
authors.lastname: Wu
authors.forename: Larry E
authors.initials: LE
authors.lastname: Kun
authors.forename: Jesse J
authors.initials: JJ
authors.lastname: Jenkins
authors.forename: Valerie
authors.initials: V
authors.lastname: McPherson
authors.forename: Judith
authors.initials: J
authors.lastname: Wilimas
authors.forename: Deborah P
authors.initials: DP
authors.lastname: Jones
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D016190:Carboplatin / Q000008:administration & dosage; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D003609:Dactinomycin / Q000008:administration & dosage; D004317:Doxorubicin / Q000008:administration & dosage; D004334:Drug Administration Schedule; D005047:Etoposide / Q000008:administration & dosage; D005260:Female; D005919:Glomerular Filtration Rate / Q000187:drug effects; D006801:Humans; D007069:Ifosfamide / Q000008:administration & dosage; D007223:Infant; D007680:Kidney Neoplasms / Q000188:drug therapy* / Q000532:radiotherapy / Q000601:surgery; D007684:Kidney Tubules / Q000187:drug effects / Q000503:physiopathology; D016014:Linear Models; D008297:Male; D009392:Nephrectomy; D011446:Prospective Studies; D016896:Treatment Outcome; D014750:Vincristine / Q000008:administration & dosage; D009396:Wilms Tumor / Q000188:drug therapy* / Q000532:radiotherapy / Q000601:surgery; D001613:beta 2-Microglobulin / Q000652:urine
chemical_list: D001613:beta 2-Microglobulin; D003609:Dactinomycin; D014750:Vincristine; D005047:Etoposide; D004317:Doxorubicin; D016190:Carboplatin; D007069:Ifosfamide