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Estimating glomerular filtration rate in children with cancer - Impact of methodology on carboplatin dosing

Lookup NU author(s): Annie Parry, Professor Alan Boddy

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Abstract

Renal-function based carboplatin dose estimation results in more reliable and reproducible drug exposure than dose estimation based on either weight or surface area. Glomerular filtration rate(GFR), a commonly used measure of renal function is estimated using 51 Cr-EDTA or 99Tc-DTPA in paediatric oncology centres in the United Kingdom. However, the methodology used (i e. number and timing of blood samples taken and correction factors applied) varies among them. The recent British Nuclear Medicine Society guidelines recommend taking 2-5 blood samples starting 2 hours after injection of the radioisotope and applying the Brochner-Mortensen (BM) correction factor to account for the rapid exponential phase of clearance of the radioisotope. We have completed a survey of existing methodologies used to determine GFR in all 21 paediatric oncology centres in UK. Using 51 Cr-EDTA data obtained from 337 GFR studies carried out on paediatric oncology patients treated in Newcastle upon Tyne we have analysed the effect different methodologies have on renal function-based carboplatin dosing A questionnaire survey revealed that the number of samples taken after isotope administration varied between 2 and 4. The BM and Chantler corrections were used in 38% (8/21) and 28% (6/21) of centres respectively. A change from Chantler to BM correction would decrease carboplatin dose by >10% in at least 15% of patients and by >25% in 2% of patients. The increase in estimated 51 Cr-EDTA half-life noted by omitting the 1hr sample would result in a carboplatin dose decrease of >10% in 21-25% of patients and >25% in 3% of patients. This study highlights variations in practice between centres and the potential clinical impact it may have on carboplatin dosing in paediatric oncology. Standard methodology for estimating GFR in children must be followed to achieve uniform dosing across different paediatric oncology centres. This project was supported by Cancer Research, UK.


Publication metadata

Author(s): Chinnaswamy, G., Keir, M., Cole, M., Price, L., Parry, A., Boddy, A. V., Veal, G. J.

Publication type: Conference Proceedings (inc. Abstract)

Publication status: Published

Conference Name: 39th Annual Conference of the International Society of Paediatric Oncology

Year of Conference: 2007

Pages: 481-481 PD.092

Publisher: Pediatric Blood and Cancer, Wiley-Liss, Inc.

URL: http://dx.doi.org/10.1002/pbc.21342

DOI: 10.1002/pbc.21342

Library holdings: Search Newcastle University Library for this item

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