Adequate nephroprotection reduces renal complications after hyperthermic intrathoracic chemotherapy

Background and Objectives

Hyperthermic intrathoracic chemotherapy (HITOC) is used for the treatment of malignant pleural tumors. Although HITOC proved to be safe, postoperative renal failure due to nephrotoxicity of intrapleural cisplatin remains a concern.

Methods

This single-center study was performed retrospectively in patients who underwent pleural tumor resection and HITOC between September 2008 and December 2018.

Results

A total of 84 patients (female n = 33; 39.3%) with malignant pleural tumors underwent surgical cytoreduction with subsequent HITOC (60 minutes; 42°C). During the study period, we gradually increased the dosage of cisplatin (100–150 mg/m² BSA n = 36; 175 mg/m² BSA n = 2) and finally added doxorubicin (cisplatin 175 mg/m² BSA/doxorubicin 65 mg; n = 46). All patients had perioperative fluid balancing. The last 54 (64.3%) patients also received perioperative cytoprotection. Overall 29 patients (34.5%) experienced renal insufficiency. Despite higher cisplatin concentrations, patients with cytoprotection showed significantly lower postoperative serum creatinine levels after 1 week (P = .006) and at discharge (P = .020). Also, they showed less intermediate and severe renal insufficiencies (5.6% vs 13.3%).

Conclusions

Adequate perioperative fluid management and cytoprotection seem to be effective in protecting renal function. This allows the administration of higher intracavitary cisplatin doses without raising the rate of renal insufficiencies.     

Zu krank für eine Vaterschaft? Andrologische Beratung bei (neuen) onkologischen Systemtherapien

Gynäkologische Endokrinologie - Bei der Verordnung von Systemtherapeutika sollte auch bei männlichen Patienten stets das Risiko einer Beeinträchtigung der Zeugungsfähigkeit...     

Effect of Two Self-Adhesive Cements on Marginal Adaptation and Strength of Esthetic Ceramic CAD/CAM Molar Crowns

Purpose: This study evaluated the effects of adhesive cements on marginal adaptation and fracture resistance of ceramic molar crowns. Materials and Methods: Seventy‐five extracted maxillary molars were selected. The occlusal morphology of 15 molars (control) was scanned and transferred to the crowns in the test groups by CAD/CAM. Sixty molars received full‐coverage crown preparations with 6‐degree axial taper, 1.0‐mm shoulder, and 2.0‐mm occlusal reduction. They were assigned to four groups, and pulpal pressure was simulated. The 15 crowns in each test group were seated with resin‐based self‐adhesive cements, Rely‐X (RX) and Multilink (MS), one multistep bonded adhesive luting composite resin, Variolink (VL), and glass‐ionomer cement, Ketac Cem (KC). Test and control molars were subjected to thermal and mechanical fatigue stress (TMS: 12,000 × 5°C to 50°C; 2.4 million × 49 N) for 18 days in a masticator. Marginal adaptation [“continuous margin%” (CM%)] of the crowns was determined by scanning electron microscopy (200×). Finally, molars were occlusally loaded until fracture in a testing machine, and fracture load (N) was recorded. Marginal adaptation and strength data were statistically analyzed. Results: TMS significantly (p < 0.001) reduced CM% in all groups. After TMS, CM% at the cement‐dentin interface was significantly (p < 0.001) higher for RX than for all other cements. At the crown‐cement interface both self‐adhesive cements MS and RX had significantly better CM% than VL (p < 0.05) and KC (p < 0.001). Fracture resistance of natural untreated molars was significantly (p < 0.001) higher than that of experimental crowns. Fracture resistance of RX cemented crowns was significantly (p < 0.05) higher than that of other crowns. Occlusal morphology significantly influenced fracture resistance (p < 0.05). Conclusions: Self‐adhesive cement RX offers a valid alternative to multistep resin‐based luting composite with respect to marginal adaptation to dentin and fracture resistance. The latter is also influenced by occlusal morphology, necessitating careful monitoring of occlusal contacts.