Anna Fagotti

Carlo Ronsini

Federica Di Maio

Giovanni Scambia

Giuseppe Grandaliano

Nicola Panocchia

Pietro Manuel Ferraro

English

Archivio Istituzionale della Ricerca - Università degli Studi della Campania "Luigi Vanvitelli"

P0563 THE SHORT AND LONG-TERM EFFECTS OF HYPERTHERMICINTRAPERITONEAL CHEMOTHERAPY ON RENAL FUNCTIONIN PLATINUM-SENSITIVE RECURRENT OVARIAN CANCERFederica Di Maio1, Anna Fagotti2, Carlo Ronsini3, Nicola Panocchia1,Giuseppe Grandaliano1,4, Giovanni Scambia4,5, Pietro Manuel Ferraro1,41Fondazione Policlinico Universitario A. Gemelli IRCCS, U.O.C. Nefrologia, Roma, Italy,2Fondazione Policlinico Universitario A Gemelli IRCCS, Dipartimento Scienze dellaSalute della Donna e del Bambino, Roma, Italy, 3Universita G. d’Annunzio, Gynecologicand Obstetrics Unit, Chieti, Italy, 4Universita Cattolica del Sacro Cuore, Roma, Italy and5Fondazione Policlinico Gemelli IRCCS, Roma, ItalyBackground and Aims:Cytoreductive surgery (CRS) with platinum based Hyperthermic IntraperitonealChemotherapy (HIPEC) represents a valid therapeutic approach in the treatment ofovarian cancer patients with peritoneal spread (vanDriel NEJM). Nevertheless, cispla-tin nephrotoxicity represents one limitation to the diffusion of HIPEC in clinical prac-tice. To date, few studies evaluated the nephrotoxicity of hyperthermic intraperitonealcisplatin and the risk of acute kidney injury (AKI) in patients treated with HIPEC. Theaim of our study is to evaluate short- and long-term changes in serum creatinine (SCr)levels in a cohort of patients with a first relapse of platinum-sensitive ovarian cancer,receiving CRS plus or minus HIPEC.Method:We compared a cohort of patients with a first relapse of platinum-sensitive ovarian can-cer, receiving CRS plus/minus HIPEC in a period from January 2013 to October 2018.The HIPEC technique required the perfusion of the abdominal cavity with a 4 L/m2 ofa heated saline solution containing cisplatin 75 mg/m2. We assessed the estimated glo-merular filtration rate (eGFR), using the CKD-EPI formula, and SCr from the preoper-ative value, at 24, 48, 72 hours, 7 days and the last SCr value available on the electronicrecord, at least 3 months after the procedure. We analyzed the effect of HIPEC treat-ment on SCr values over time and we used logistic regression models to investigate theeffect of HIPEC treatment on clinical outcomes. No patient in the HIPEC group hadkidney protective treatment with thiosulphate.Results:Our analyses included complete data of 110 patients treated in our Institution fromJanuary 2013 to October 2018. The two groups had significant differences in baselineSCr (p-value = 0.002), with lower average values in the CRS+HIPEC group (mean 0.68,standard deviation [SD] 0.14 mg/dL) compared to the CRS group (mean 0.76, SD 0.13mg/dL). The baseline eGFR was significantly higher in the CRS+HIPEC group (mean95, SD 16 mL/min/1.73 m2) than in the CRS group (mean 88, SD 14 mL/min/1.73 m2)(p-value = 0.014) and three patients in each group had chronic kidney disease (CKD)before surgery. SCr values in the HIPEC group were significantly higher at post-opera-tive day #7 (1.22 6 1.10 mg/dL vs 0.69 6 0.16 mg/dL; p-value<0.001) and the differen-ces remained during follow-up at least three months after randomization (0.96 6 0.55vs 0.69 6 0.19 mg/dL; p-value<0.001). Seventeen patients (31%) developed AcuteKidney Injury (AKI), according to the KDIGO Guidelines, in the first week afterCRS+HIPEC versus seven patients (13%) after CRS alone. No patients who developedAKI post-HIPEC needed renal replacement treatment, although 5 (9%) had AKI stageIII and 7 (13%) stage II. The CRS+HIPEC group had a significantly higher risk of devel-oping AKI [OR: 3.48 (2.30-5.27)] compared with the CRS group (p-value<0.001).There were no statistically significant differences between the two groups with regard torisk of complications other than AKI.Conclusion:To our knowledge, our study represents the first investigation on short- and long-termchanges in SCr and on the risk of AKI in patients with a first relapse of platinum-sensi-tive ovarian cancer, treated with CRS and HIPEC. There is a strong correlation betweenthe intraperitoneal cisplatin at elevated temperatures and the rise of SCr over the time.However, this event was no reversible and influenced following treatments in only eightwomen.Figure 1. Scatter plot of serum creatinine values as function of the time of treatmentFigure 2. Linear prediction of serum creatinine as function of the time of treatmentAbstracts Nephrology Dialysis Transplantationiii882 | AbstractsDownloaded from https://academic.oup.com/ndt/article/35/Supplement_3/gfaa142.P0563/5853038 by guest on 06 March 2021

THE SHORT AND LONG-TERM EFFECTS OF HYPERTHERMIC INTRAPERITONEAL CHEMOTHERAPY ON RENAL FUNCTION IN PLATINUM-SENSITIVE RECURRENT OVARIAN CANCER

https://iris.unicampania.it/bitstream/11591/468399/1/P0563%20THE%20SHORT%20AND%20LONG-TERM%20EFFECTS%20OF%20HYPERTHERMIC%20INTRAPERITONEAL%20CHEMOTHERAPY%20ON%20RENAL%20FUNCTION%20IN%20PLATINUM-SENSITIVE%20RECURRENT%20OVARIAN%20CANCER.pdf

THE SHORT AND LONG-TERM EFFECTS OF HYPERTHERMIC INTRAPERITONEAL CHEMOTHERAPY ON RENAL FUNCTION IN PLATINUM-SENSITIVE RECURRENT OVARIAN CANCER

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