Amifostine Protects Against Cisplatin-Induced Nephrotoxicity in a Child with Medulloblastoma

Abstract

Amifostine (WR-2721, Ethyol) (S-2-(3-aminopropylamino)-ethylphosphorothioic acid) protects normal tissue from the cytotoxic damage induced by radiation and by chemotherapy. Several studies in adults have shown that amifostine reduces the cumulative renal toxicities associated with cisplatin, with no reduction in its anti-tumor efficacy [1, 2]. In the pediatric age group, amifostine has also been shown to be well tolerated and to ameliorate the myelotoxicity from alkylating agents and from cisplatin, in a variety of solid tumors [3, 4]. We describe the first reported case of the use of amifostine to protect against cisplatin-induced nephrotoxicity in a child with medulloblastoma who had a solitary kidney. A 7-year-old boy was referred with complaints of headache, vomiting, and diplopia. Magnetic resonance imaging (MRI) scan of the brain showed an enhancing tumor 3 cm in diameter located in the cerebellar vermis, invading the right cerebellar hemisphere, and partially filling the fourth ventricle, with moderate internal hydrocephalus. MRI scan of the spine demonstrated gross nodular seedlings in the thoraco-lumbar subarachnoid space. The tumor was staged as T2M3 according to the classification by Chang et al. [5]. The patient underwent posterior fossa decompression and a partial resection of the tumor mass with less than 50% residual disease demonstrated postoperatively. Histopathological analysis confirmed the diagnosis of medulloblastoma. Within 28 days of surgery, he began radiation therapy and received 3780 cGy to the craniospinal axis with a 1980-cGy boost to the local tumor site (a total radiation dose to the tumor site of 5760 cGy). Daily fractions of