Cancer Clinical Trial
Official title:
Value of Tc-99m Renography for Early Diagnosis of Cisplatin-induced Renal Toxicity
Cisplatin is a heavy-metal complex widely used in the treatment of a variety of
malignancies, including small cell and non-small cell lung cancer, ovarian, bladder, head
and neck, esophageal, cervical and germ cell tumors. The administration of cisplatin is
commonly associated with certain drug-induced toxicities that may limit their clinical
utility and adversely affect the quality of life of patients undergoing treatment. Although
many advances have been made in reducing some of the toxicities associated with platinum
drug therapy, it is clear that dose-limiting nephrotoxicity remains a major stumbling block
in the use of this compound. Subtle changes in renal function occur without overt renal
insufficiency, consisting of a decrease in effective renal plasma flow and tubular
dysfunction despite aggressive hydratation. Early tubular damage occurring within 1 to 3
hours after cisplatin administration has been demonstrated by measurement of urinary beta
2-microglobulin, a sensitive marker of tubular injury. The chronic lesion has become of
greater concern in recent years as many patients have been cured or placed into long-term
remission due to cisplatin treatment. It consists of a decrease in glomerular filtration
rate, which is not necessary characterized by a remarkable increase in serum creatinine.
Cumulative tubular damage has been demonstrated by increased urinary excretion of tubular
enzymes such as alanine aminopeptidase and beta 2-microglobulin. In this setting, predicting
the occurrence of chronic cisplatin-induced nephrotoxicity remains a clinical challenge.
Tc-99m mercaptoacetyltriglycine (MAG3) is predominantly a proximal tubular secretion renal
agent without cortical fixation indicated for dynamic renal studies to evaluate cortical
tubular function and collecting system drainage. Tc-99m MAG3 and is the agent of choice for
obstructive uropathy and diffuse functional abnormalities of the renal cortex. The aim of
this study was to evaluate by means of Tc-99m MAG3 scintigraphy the acute and subacute
impairment of tubular secretion after cisplatin administration in patients with head and
neck cancer receiving chemotherapy.
n/a
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