Radiation effects on renal function

Long-term renal function after treatment for malignant germ-cell tumours

OBJECTIVE

To evaluate prospectively renal function in patients with malignant germ-cell tumours (MGCTs) >10 years after retroperitoneal lymph node dissection alone (RPLND), radiotherapy alone (RAD) or different schedules of cisplatin-based chemotherapy with or without surgery/radiotherapy (CHEM).

PATIENTS AND METHODS

In 85 patients, three groups were identified: RPLND, 14; RAD, 18; CHEM, 53, with subdivision of the latter group according to the cumulative cisplatin dose or the additional use of radiotherapy. Renal function was determined by 131Iodine Hippuran clearance or 99m DTPA glomerular filtration rate, and was assessed before treatment and four times during 14 years of follow-up. A value of <70% of the upper limit of the normal range identified impaired renal function.

RESULTS

Twenty-five patients displayed long-term impaired renal function, 23 of them from the RAD or CHEM group. In the RAD group, renal function decreased by 8%, whereas a 14% reduction of renal function was observed in the CHEM group. In the CHEM group the cumulative dose of cisplatin, and in the RAD group the age at treatment, were associated with impairment of renal function. Combining all patients, age at treatment and the type of treatment were associated with impaired renal function.

CONCLUSIONS

In 20-30% of the patients with germ-cell tumour, standard radiotherapy and chemotherapy strategies are followed by long-term subclinical impaired renal function. These findings support current intentions to avoid overtreatment with these treatment modalities.

Renal allograft autotransplantation before pelvic irradiation

The anatomical location of a renal allograft places the kidney in jeopardy during radiation therapy of pelvic and perineal malignancies. Alternative choices include avoiding irradiation, altering the dose, or excluding the graft from the field of radiation, with the risk of compromising the efficacy of the treatment. Transplantation of the graft out of the field of irradiation is another option. We describe the management, by allograft autotransplantation, of a renal transplant patient with an invasive carcinoma of the vulva for which postoperative inguinopelvic radiotherapy was advocated. This report underlines the technical difficulties encountered during reoperation on an allograft and the need for versatility in vascular and urologic reconstructions. With these reservations, autotransplantation permits the recovery of a normal renal function and is an option to consider in the salvage of a kidney transplant.