Aass N, Fosså S D, Aas M, Lindegaard M W
Department of Medical Oncology and Radiotherapy, Norwegian Radium Hospital, Oslo.
Br J Cancer. 1990 Nov;62(5):842-6. doi: 10.1038/bjc.1990.391.
The renal function was evaluated with 131I-Hippuran clearance in 171 patients with malignant germ cell tumours. Assessments were performed before treatment and at three fixed times afterwards within 5 years. The patients were treated with surgery only (20 patients), infra-diaphragmatic radiotherapy only (median midplane dose 36 Gy) (48 patients), cisplatin-based chemotherapy (total cisplatin dose 500-850 mg) plus surgery (64 patients), cisplatin-based chemotherapy (total cisplatin dose greater than 850 mg) with or without surgery (23 patients) or cisplatin-based chemotherapy (total cisplatin dose 500-850 mg) plus infra-diaphragmatic radiotherapy (16 patients). No renal impairment was observed for patients treated with surgery only. In patients who received radiotherapy no change of the renal function occurred during the first year post-treatment. Three to five years after treatment discontinuation a statistically significant reduction within the normal range was observed in patients who were greater than 40 years at the time of irradiation. Cisplatin-based chemotherapy led to a statistically significant irreversible renal impairment for all the three groups. The greatest reduction was seen in patients who received the highest total cisplatin dose or who were treated with irradiation in addition to chemotherapy. The clinical significance of the observed nephrotoxicity is still unknown.
对171例恶性生殖细胞肿瘤患者采用131I-马尿酸清除率评估肾功能。在治疗前以及之后5年内的三个固定时间点进行评估。患者接受的治疗方式包括单纯手术（20例患者）、仅膈下放疗（中平面剂量中位数为36 Gy）（48例患者）、以顺铂为基础的化疗（顺铂总剂量500 - 850 mg）加手术（64例患者）、以顺铂为基础的化疗（顺铂总剂量大于850 mg）加或不加手术（23例患者）或以顺铂为基础的化疗（顺铂总剂量500 - 850 mg）加膈下放疗（16例患者）。仅接受手术治疗的患者未观察到肾功能损害。接受放疗的患者在治疗后第一年肾功能未发生变化。在放疗时年龄大于40岁的患者中，治疗停止3至5年后观察到在正常范围内有统计学意义的降低。以顺铂为基础的化疗在所有三组中均导致有统计学意义的不可逆肾功能损害。在接受顺铂总剂量最高的患者或除化疗外还接受放疗的患者中观察到最大程度的降低。所观察到的肾毒性的临床意义仍不清楚。
