Chinnaswamy G, Cole M, Boddy A V, Keir M, Price L, Parry A, English M, Veal G J
Northern Institute for Cancer Research, University of Newcastle upon Tyne, Newcastle upon Tyne NE2 4HH, UK.
Br J Cancer. 2008 Sep 16;99(6):894-9. doi: 10.1038/sj.bjc.6604612.
Renal function-based carboplatin dosing is used routinely in paediatric oncology clinical practice. It is important that accurate assessments of renal function are carried out consistently across clinical centres, a view supported by recently published British Nuclear Medicine Society (BNMS) guidelines for measuring glomerular filtration rate (GFR). These guidelines recommend the use of a radioisotope method for GFR determination, with between two and five blood samples taken starting 2 h after radioisotope injection and application of the Brochner-Mortensen (BM) correction factor. To study the likely impact of these guidelines, we have investigated current practices of measuring GFR in all 21 Children's Cancer and Leukaemia Group (CCLG) paediatric oncology centres in the United Kingdom. This information was used to evaluate the potential impact on renal function-based carboplatin dosing using raw 51Cr-EDTA clearance data from 337 GFR tests carried out in children with cancer. A questionnaire survey revealed that between two and four samples were taken after isotope administration, with BM and Chantler corrections used in 38% (8/21) and 28% (6/21) of centres, respectively. A change from Chantler to BM correction, based on the BNMS guidelines, would result in a > 10% decrease in carboplatin dose in at least 15% of patients and a > 25% decrease in 2% of patients. A greater proportion of patients would have an alteration in carboplatin dose when centres not using any correction factor implement the BM correction. The increase in estimated 51Cr-EDTA half-life observed by omitting the I h sample decreases carboplatin dose by > 10% in 23-52% of patients and by > 25% in 3% of patients. This study highlights current variations in renal function measurement between clinical centres and the potential impact on carboplatin dosing. A standard methodology for estimating GFR should be followed to achieve uniform dosing in children with cancer.
基于肾功能的卡铂给药方案在儿科肿瘤临床实践中常规使用。各临床中心持续进行准确的肾功能评估非常重要,这一观点得到了最近发布的英国核医学学会(BNMS)肾小球滤过率(GFR)测量指南的支持。这些指南推荐使用放射性同位素方法测定GFR,在放射性同位素注射后2小时开始采集两到五份血样,并应用布罗chner - 莫滕森(BM)校正因子。为研究这些指南可能产生的影响,我们调查了英国所有21个儿童癌症与白血病研究组(CCLG)儿科肿瘤中心测量GFR的当前做法。利用来自337例癌症患儿GFR检测的原始51Cr - EDTA清除率数据,该信息用于评估对基于肾功能的卡铂给药的潜在影响。问卷调查显示,同位素给药后采集了两到四份血样,分别有38%(8/21)和28%(6/21)的中心使用了BM校正和钱特勒校正。根据BNMS指南,从钱特勒校正改为BM校正,至少15%的患者卡铂剂量将减少> 10%,2%的患者将减少> 25%。当未使用任何校正因子的中心实施BM校正时,更大比例的患者卡铂剂量会改变。通过省略1小时血样观察到的估计51Cr - EDTA半衰期增加,使23 - 52%的患者卡铂剂量减少> 10%,3%的患者减少> 25%。本研究突出了临床中心之间目前在肾功能测量方面的差异以及对卡铂给药的潜在影响。应遵循一种标准的GFR估计方法,以实现癌症患儿给药的一致性。