Abstract:
Background: Cervical cancer is the leading cause of cancer deaths in women with 90%
occurring in low and middle-income countries. The gold standard of treatment for
locally advanced cervical cancer is concurrent chemoradiation with cisplatin, cisplatin
serves as a radiosensitizer.However, cisplatin is known to be toxic to the kidney,leading
to dose delays and treatment cessation. This study aims to determine whether mannitol
prevents Cisplatin induced acute kidney injury during chemoradiation therapy for
cervical cancer.
Objective: To evaluate the effectiveness of Mannitol using the rate of averted acute
kidney injury and completion rate among patients with cervical cancer undergoing
chemoradiation treatment in MTRH and Eldoret Hospital.
Methods: It was a double blind randomized clinical trial study involving 50 women
with cervical cancer stage 1B up to 2B underwent chemoradiation at MTRH and
Eldoret Hospital. Patients were naive to chemotherapy and radiotherapy. Patients were
randomly assigned into two arms of 25 each (intervention and control). Intervention
arm received mannitol 20% (200mls) with standard chemotherapy regimen (Cisplatin
40mg/m2) and the control arm received standard chemotherapy regimen as per the
protocol along with 200mls of Normal Saline as placebo. All patients underwent 25
sessions of external beam radiation at 1 to 1.5 Grays per session. Weekly kidney
function of patients was collected. Data was collected using structured questionnaire
and analyzed. The outcome measured was the rate of averted acute kidney injury and
the time of chemotherapy completion in both arms.
Results: The average age in the control and intervention group was 52.8 and 50.6 The
rate of averted AKI was 96% in the intervention arm and 92% in the control arm.The
time of chemoradiation completion was the same among both arms.
Conclusion: We do not have enough evidence to conclude that the proportion with
averted AKI or the time to completion differed between the two groups.
Recommendation: Further studies should be done to evaluate the effectiveness of
Mannitol in preventing of CIN and AKI.
