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Long-term renal function after treatment for malignant germ-cell tumours
S D Fosså1, N Aass, M Winderen
1Department of Medical Oncology and Radiotherapy, The Norwegian Radium Hospital, Oslo. s.d.fossa@klinmed.uio.no
Summary
Malignant germ-cell tumour treatments like chemotherapy and radiotherapy can lead to long-term kidney impairment in 20-30% of patients. This highlights the need to avoid overtreatment and preserve renal function.
Area of Science:
- Oncology
- Nephrology
- Radiology
Background:
- Malignant germ-cell tumours (MGCTs) require multimodal treatment, including surgery, radiotherapy, and chemotherapy.
- Long-term renal function after treatment for MGCTs is a significant concern, particularly with cisplatin-based regimens and radiotherapy.
Purpose of the Study:
- To prospectively assess long-term renal function in MGCT patients treated with retroperitoneal lymph node dissection (RPLND), radiotherapy alone (RAD), or chemotherapy (CHEM).
- To identify factors associated with impaired renal function post-treatment for MGCTs.
Main Methods:
- Prospective evaluation of 85 MGCT patients over 14 years.
- Renal function assessed using 131Iodine Hippuran clearance or 99m DTPA glomerular filtration rate.
- Impaired renal function defined as <70% of the upper limit of normal.
Main Results:
- Twenty-five patients (29%) showed long-term impaired renal function, primarily in the RAD (18 patients) and CHEM (53 patients) groups.
- Renal function decreased by 8% in the RAD group and 14% in the CHEM group.
- Cumulative cisplatin dose and age at treatment were associated with renal impairment in the CHEM and RAD groups, respectively.
Conclusions:
- Standard radiotherapy and chemotherapy for MGCTs result in long-term subclinical renal dysfunction in 20-30% of patients.
- Age at treatment and treatment modality are key factors influencing renal function outcomes.
- Findings support strategies to minimize overtreatment and preserve renal health in MGCT survivors.