Renal Toxity of Chemotherapy for Bone and Soft Tissue Sarcoma

Abstract

Chemotherapy for sarcoma was associated with some side effects of renal hypofunction; For instance an increase in serum creatinine and urine nitrogen concentration, tetany due to hypocalcemia and magnesemia and delayed excretion of several drugs including anticancer medications. These side effects were seen in four patients following chemotherapy for osteosarcoma and malignant fibrous histiocytoma (MFH). Cisplatin (CDDP) which was found to be the most toxic agent was administrated to all patients. Highdose methotrexate (HD-MTX) with citrovorum factor (CF) rescue and ifosfamide were added for treatment of osteosarcoma. Ifosfamide was also added for MFH.
Despite adequate hydration a temporary decrease of creatinine clearance occured which took one to several weeks to recover. Transfusion of serum protein and red blood cells improved the recovery of renal function. Tetany attacks which were prevented by continuous infusion of Ca and Mg tended to happen when renal function was beginning to decrease. Repeated CDDP administration caused irreversible renal hypofunction and delayed excretion of serum MTX after HD-MTX chemotherapy in two cases. Careful monitoring of serum MTX and administration of CF prevented severe side effects due to MTX.
It is important to pay careful attention to renal toxicity and delayed excretion of several drugs in intensive chemotherapy for sarcoma.