Nishimura Goshi, Horiuchi Choichi, Yoshida Takafumi, Kawakami Mariko, Yabuki Kenichiro, Taguchi Takahide, Nagao Junichi, Kondo Norio, Masuda Yoko, Matsuda Hideki, Mikami Yasukazu, Tsukuda Mamoru
Dept. of Otorhinolaryngology, Yokohama City University School of Medicine.
Gan To Kagaku Ryoho. 2006 Apr;33(4):463-6.
Most of the head and neck tumors are squamous cell carcinomas (SCCs), which are relatively sensitive to chemotherapeutic agents. Cis-platinum (CDDP), 5-fluorouracil and taxanes are widely used worldwide for SCCs, and CDDP is the most common agent. Renal toxicity is a well-known adverse effect of CDDP, and adequate pre and post-hydration or combined administration of neutralizing agents is performed during CDDP injection. Before the CDDP administration, we have to evaluate renal function of the patients using creatinine clearance rate (Ccr). In Japan, CDDP at the dose of 60-70 mg/m(2)/day is administered in cases with over 65 ml/min/1.73 m(2) of Ccr, whereas in cases under 60 ml/min/1.73 m(2), we use other drugs, e.g., carboplatin, to prevent the renal dysfunction followed by chemotherapy. In other countries, the dose of CDDP is 70-100 mg/m(2)/day, and the discrepancy is based on the poor renal function of Japanese. We calculated Ccrs of 107 head and neck cancer patients since January, 2004 to August, 2005, and evaluated renal function before any treatment. Ccr was decreased in proportion to aging. At the age of fifties, 43.5% of the patients indicated lower Ccr than 65 ml/min/1.73 m(2): sixties, 45.7%; seventies, 50.0%; and eighties, 85.7%. In the United States, the average glomerular filtration rate of over 70 year-old healthy people is estimated as 75 ml/min/ 1.73 m(2), and it is considered sufficient kidney function for the administration of CDDP at the dose of 70-100 mg/ m(2)/day. The incident rate of end-stage renal disease is 1.3 times higher in the United States than in Japan. The incident rate of diabetes, which is the main cause of renal dysfunction, is almost the same in both countries. Though the reason is unclear, it is the fact that the renal function of Japanese decreases quickly in accordance with aging.
大多数头颈部肿瘤为鳞状细胞癌（SCC），这类肿瘤对化疗药物相对敏感。顺铂（CDDP）、5-氟尿嘧啶和紫杉烷在全球范围内被广泛用于治疗SCC，其中CDDP是最常用的药物。肾毒性是CDDP众所周知的不良反应，在注射CDDP期间需进行充分的水化预处理和后处理，或联合使用中和剂。在给予CDDP之前，我们必须使用肌酐清除率（Ccr）来评估患者的肾功能。在日本，对于Ccr超过65 ml/min/1.73 m²的患者，给予60 - 70 mg/m²/天剂量的CDDP；而对于Ccr低于60 ml/min/1.73 m²的患者，我们使用其他药物，如卡铂，以预防化疗后出现肾功能障碍。在其他国家，CDDP的剂量为70 - 100 mg/m²/天，这种差异是基于日本人较差的肾功能。自2004年1月至2005年8月，我们计算了107名头颈部癌患者的Ccr，并在任何治疗前评估了他们的肾功能。Ccr随年龄增长而降低。在五十岁时，43.5%的患者Ccr低于65 ml/min/1.73 m²；六十岁时为45.7%；七十岁时为50.0%；八十岁时为85.7%。在美国，70岁以上健康人的平均肾小球滤过率估计为75 ml/min/1.73 m²，这被认为是给予70 - 100 mg/m²/天剂量CDDP的足够肾功能。美国终末期肾病的发病率比日本高1.3倍。作为肾功能障碍主要原因的糖尿病发病率在两国几乎相同。尽管原因尚不清楚，但事实是日本人的肾功能会随着年龄增长而迅速下降。
