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, Tc99m-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 V20 (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 V20 (left kidney) and mean left kidney dose were identified as parameters associated with decreased kidney function. Mean serum creatinine was increased from 74.6 micromol/L before treatment to 86.1 micromol/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.
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, Tc99m-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 V20 (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 V20 (left kidney) and mean left kidney dose were identified as parameters associated with decreased kidney function. Mean serum creatinine was increased from 74.6 micromol/L before treatment to 86.1 micromol/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.
Authors: Johan L Dikken; Cornelis J H van de Velde; Daniel G Coit; Manish A Shah; Marcel Verheij; Annemieke Cats Journal: Therap Adv Gastroenterol Date: 2012-01 Impact factor: 4.409
Authors: Johan L Dikken; Johanna W van Sandick; H A Maurits Swellengrebel; Pehr A Lind; Hein Putter; Edwin P M Jansen; Henk Boot; Nicole C T van Grieken; Cornelis J H van de Velde; Marcel Verheij; Annemieke Cats Journal: BMC Cancer Date: 2011-08-02 Impact factor: 4.430
Authors: Kilian Salerno May; Gary Y Yang; Nikhil I Khushalani; Rameela Chandrasekhar; Gregory E Wilding; Leayn Flaherty; Harish K Malhotra; Richard C Russo; John C Warner; Johnny C Yap; Renuka V Iyer; Chukwumere E Nwogu; Saikrishna S Yendamuri; John F Gibbs; Hector R Nava; Dominick Lamonica; Charles R Thomas Journal: J Gastrointest Oncol Date: 2010-09
Authors: Karyn A Goodman; Najma Khalid; Lisa A Kachnic; Bruce D Minsky; Cheryl Crozier; Jean B Owen; Phillip M Devlin; Charles R Thomas Journal: Int J Radiat Oncol Biol Phys Date: 2012-10-03 Impact factor: 7.038