Post chemotherapy hydration and acute kidney injury in patients undergoing concurrent cisplatin chemoradiotherapy (CRT) for head and neck cancers


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Jacqueline Grove1,Joanna Mackenzie1,Aravindhan Sundaramurthy1
1Western General Hospital

Abstract

Background

At the Edinburgh Cancer Centre (ECC) a retrospective review of new head and neck cancer patients in 2012-13 showed a rate of acute kidney injury1 (AKI) following concurrent cisplatin CRT of 27%. This was despite routine pre- and post-cisplatin hydration on Day 1 and Day 2 of each cycle.

Following the 2013 review, the ECC protocol for concurrent cisplatin CRT was changed from 3 to 4 weekly cisplatin (100mg/m2 on Day 1 and 29 of radiotherapy) and additional fluids were added on Day 3 and 4 of the cycle. This review seeks to assess whether these changes have reduced the rate of AKI in such patients.

Method

Patients received a total of 4L intravenous hydration fluids on day 1 and 2 as per standard protocol.2 Additional fluids of 1L 0.9% sodium chloride over 2 hours were also given on days 3 and 4 of each cycle.

A further retrospective review was then carried out for patients commencing and completing CRT between 1st September 2015 and 30th April 2016.

Results

 2012-13 2012-13 2015-16 2015-16  No.%No.% Total75 10033100 AKI requiring hospital admission20 2726

 

Cisplatin chemotherapy:

     3 weekly26 352*6 4 weekly40 5323705 weekly--26Changed/ omitted post cycle 1912618

 

*De-Escalate Trial patients

A chi-squared test was performed, which showed a significant difference in the rates of AKI between the two groups (p = 0.012).

Conclusion

Changes in this regimen from 3 to 4 weekly administration as well as additional fluids on days 3 and 4 of each cycle have significantly reduced the rate of AKI for patients undergoing concurrent cisplatin CRT and the number of hospital admissions has reduced from 27 to 6%.