title: Comparative analysis of cisplatin-induced nephrotoxicity in head and neck cancer and carcinoma cervix during concurrent chemoradiotherapy.
abstract: BACKGROUND
  Cisplatin is widely used as radio sensitizer in head and neck cancer (HNC) and carcinoma cervix (CaCx). This study aims to see comparative nephrotoxicity of cisplatin in HNC and in CaCx without obstructive uropathy treated by concurrent chemoradiotherapy (CCRT).
  
  
  METHODS
  Fifty patients of HNC and 50 patients of CaCx stage II/III without obstructive uropathy were included in this study. Cisplatin 50 mg intravenous weekly was given before EBRT with adequate hydration and premedication in both groups. Before chemotherapy; blood urea, serum creatinine, and glomerular filtration rate (GFR) were measured. GFR was measured using (99m)Tc diethylene triamine pentacaetic acid (DTPA) renogram study.
  
  
  RESULTS
  At the end of 4(th) week, blood urea level 41-45 mg% was in 40 and 4% in HNC and CaCx, respectively (P = 0.018). At the end of 3(rd) and 4(th) week, blood urea level >45 mg% was 10 and 6% in HNC cases, respectively. At the end of 4(th) week, serum creatinine level 1.1-1.5 mg% was 50 and 8% in HNC and CaCx, respectively (P = 0.047). Serum creatinine level >1.5 mg% was 6, 8, and 22% in HNC at the end of 2(nd), 3(rd), and 4(th) week, respectively. GFR <80 ml/min at the end of 4(th) week was 14% in HNC and only 2% in CaCx. GFR <100ml/min was significant at the end of 4(th) week (P = 0.04). Univariate analysis showed significant relation between reduced oral fluid intake and reduced GFR (P < 0.001).
  
  
  CONCLUSIONS
  In HNC, during concurrent chemoradiation, as the 3(rd)-4(th) week is reached, oral mucosal reactions increase and affect oral intake which further add to the cisplatin-induced nephrotoxicity. In CaCx without obstructive uropathy, renal function impairment is less severe as oral intake of water and liquid is not much impaired.
authors.affiliation: Department of Radiation Oncology, Acharya Tulsi Regional Cancer Treatment and Research Institute, Bikaner, Rajasthan, India.
authors.forename: Puneet Kumar
authors.initials: PK
authors.lastname: Bagri
authors.affiliation: Department of Radiation Oncology, Acharya Tulsi Regional Cancer Treatment and Research Institute, Bikaner, Rajasthan, India.
authors.forename: Akhil
authors.initials: A
authors.lastname: Kapoor
authors.affiliation: Department of Medical Oncology, Acharya Tulsi Regional Cancer Treatment and Research Institute, Bikaner, Rajasthan, India.
authors.forename: Ashok
authors.initials: A
authors.lastname: Kalwar
authors.affiliation: Department of Radiation Oncology, Acharya Tulsi Regional Cancer Treatment and Research Institute, Bikaner, Rajasthan, India.
authors.forename: Mukesh Kumar
authors.initials: MK
authors.lastname: Singhal
authors.affiliation: Department of Radiation Oncology, Acharya Tulsi Regional Cancer Treatment and Research Institute, Bikaner, Rajasthan, India.
authors.forename: Daleep
authors.initials: D
authors.lastname: Singh
authors.affiliation: Department of Radiation Oncology, Acharya Tulsi Regional Cancer Treatment and Research Institute, Bikaner, Rajasthan, India.
authors.forename: Satya
authors.initials: S
authors.lastname: Narayan
keywords: Carcinoma cervix; cisplatin-induced nephrotoxicity; diethylene triamine pentacaetic acid scan; glomerular filtration rate; head and neck cancer