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Title: Prospective study on late renal toxicity following postoperative chemoradiotherapy in gastric cancer

Abstract

Purpose: Postoperative chemoradiotherapy in gastric cancer improves locoregional control and survival. Reports on late toxicity, however, have been scarce thus far. Because renal toxicity is one of the most serious late complications in upper abdominal radiotherapy, we prospectively analyzed kidney function in patients who underwent postoperative chemoradiotherapy for gastric cancer. Patients and Methods: In 44 patients, Tc{sup 99m}-thiatide renography was performed before and at regular intervals after postoperative chemoradiotherapy. The left-to-right (L/R) ratio was used as an index of the relative kidney function. Mean L/R values were calculated for four follow-up time intervals. For all patients, kidney V{sub 20} (percentage of the volume of the kidney that received more than 20 Gy) and mean dose of both kidneys were retrieved from the three-dimensional dose-volume histograms. Results: We observed a progressive decrease in left renal function of 11% (p = 0.012) after 6 months, up to 52% (p < 0.001) after >18 months. The V{sub 20} (left kidney) and mean left kidney dose were identified as parameters associated with decreased kidney function. Mean serum creatinine was increased from 74.6 {mu}mol/L before treatment to 86.1 {mu}mol/L at 1 year after chemoradiotherapy (p < 0.001). In patients with a follow-up of 18-28 months,more » one case of severe renovascular hypertension was observed. Conclusion: A progressive relative functional impairment of the left kidney in patients after postoperative chemoradiotherapy for gastric cancer is demonstrated. To optimize the survival benefit that can be established with adjuvant regimens, strategies to minimize the dose to the kidneys and other critical organs should be explored.« less

Authors:
 [1];  [2];  [3];  [4];  [4];  [2];  [3];  [4];  [5];  [4];  [4]
  1. Department of Radiotherapy, Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam (Netherlands). E-mail: epm.jansen@nki.nl
  2. Department of Radiation Oncology, Christie Hospital NHS Trust, Manchester (United Kingdom)
  3. Department of Gastroenterology, Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam (Netherlands)
  4. Department of Radiotherapy, Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam (Netherlands)
  5. Department of Nuclear Medicine, Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam (Netherlands)
Publication Date:
OSTI Identifier:
20944729
Resource Type:
Journal Article
Resource Relation:
Journal Name: International Journal of Radiation Oncology, Biology and Physics; Journal Volume: 67; Journal Issue: 3; Other Information: DOI: 10.1016/j.ijrobp.2006.09.012; PII: S0360-3016(06)02991-9; Copyright (c) 2007 Elsevier Science B.V., Amsterdam, Netherlands, All rights reserved; Country of input: International Atomic Energy Agency (IAEA)
Country of Publication:
United States
Language:
English
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; CARCINOMAS; COMBINED THERAPY; CREATININE; CRITICAL ORGANS; HYPERTENSION; KIDNEYS; PATIENTS; RADIATION DOSES; RADIOTHERAPY; RENOGRAPHY; TECHNETIUM 99; TOXICITY

Citation Formats

Jansen, Edwin, Saunders, Mark P., Boot, Henk, Oppedijk, Vera, Dubbelman, Ria, Porritt, Bridget, Cats, Annemieke, Stroom, Joep, Valdes Olmos, Renato, Bartelink, Harry, and Verheij, Marcel. Prospective study on late renal toxicity following postoperative chemoradiotherapy in gastric cancer. United States: N. p., 2007. Web. doi:10.1016/j.ijrobp.2006.09.012.
Jansen, Edwin, Saunders, Mark P., Boot, Henk, Oppedijk, Vera, Dubbelman, Ria, Porritt, Bridget, Cats, Annemieke, Stroom, Joep, Valdes Olmos, Renato, Bartelink, Harry, & Verheij, Marcel. Prospective study on late renal toxicity following postoperative chemoradiotherapy in gastric cancer. United States. doi:10.1016/j.ijrobp.2006.09.012.
Jansen, Edwin, Saunders, Mark P., Boot, Henk, Oppedijk, Vera, Dubbelman, Ria, Porritt, Bridget, Cats, Annemieke, Stroom, Joep, Valdes Olmos, Renato, Bartelink, Harry, and Verheij, Marcel. Thu . "Prospective study on late renal toxicity following postoperative chemoradiotherapy in gastric cancer". United States. doi:10.1016/j.ijrobp.2006.09.012.
@article{osti_20944729,
title = {Prospective study on late renal toxicity following postoperative chemoradiotherapy in gastric cancer},
author = {Jansen, Edwin and Saunders, Mark P. and Boot, Henk and Oppedijk, Vera and Dubbelman, Ria and Porritt, Bridget and Cats, Annemieke and Stroom, Joep and Valdes Olmos, Renato and Bartelink, Harry and Verheij, Marcel},
abstractNote = {Purpose: Postoperative chemoradiotherapy in gastric cancer improves locoregional control and survival. Reports on late toxicity, however, have been scarce thus far. Because renal toxicity is one of the most serious late complications in upper abdominal radiotherapy, we prospectively analyzed kidney function in patients who underwent postoperative chemoradiotherapy for gastric cancer. Patients and Methods: In 44 patients, Tc{sup 99m}-thiatide renography was performed before and at regular intervals after postoperative chemoradiotherapy. The left-to-right (L/R) ratio was used as an index of the relative kidney function. Mean L/R values were calculated for four follow-up time intervals. For all patients, kidney V{sub 20} (percentage of the volume of the kidney that received more than 20 Gy) and mean dose of both kidneys were retrieved from the three-dimensional dose-volume histograms. Results: We observed a progressive decrease in left renal function of 11% (p = 0.012) after 6 months, up to 52% (p < 0.001) after >18 months. The V{sub 20} (left kidney) and mean left kidney dose were identified as parameters associated with decreased kidney function. Mean serum creatinine was increased from 74.6 {mu}mol/L before treatment to 86.1 {mu}mol/L at 1 year after chemoradiotherapy (p < 0.001). In patients with a follow-up of 18-28 months, one case of severe renovascular hypertension was observed. Conclusion: A progressive relative functional impairment of the left kidney in patients after postoperative chemoradiotherapy for gastric cancer is demonstrated. To optimize the survival benefit that can be established with adjuvant regimens, strategies to minimize the dose to the kidneys and other critical organs should be explored.},
doi = {10.1016/j.ijrobp.2006.09.012},
journal = {International Journal of Radiation Oncology, Biology and Physics},
number = 3,
volume = 67,
place = {United States},
year = {Thu Mar 01 00:00:00 EST 2007},
month = {Thu Mar 01 00:00:00 EST 2007}
}