Anouk Kirsten Trip1, Jasper Nijkamp1, Harm van Tinteren2, Annemieke Cats3, Henk Boot3, Edwin Petrus Marianus Jansen1, Marcel Verheij4. 1. Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands. 2. Department of Biometrics, The Netherlands Cancer Institute, Amsterdam, The Netherlands. 3. Department of Gastroenterology and Hepatology, The Netherlands Cancer Institute, Amsterdam, The Netherlands. 4. Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands. Electronic address: m.verheij@nki.nl.
Abstract
OBJECTIVE: This observational study compares the effect of different radiotherapy techniques on late nephrotoxicity after postoperative chemoradiotherapy for gastric cancer. PATIENTS AND METHODS: Dosimetric parameters were compared between AP-PA, 3D-conformal and IMRT techniques. Renal function was measured by (99m)Tc-MAG-3 renography, glomerular filtration rate (GFR) and the development of hypertension. Mixed effects models were used to compare renal function over time. RESULTS: Eighty-seven patients treated between 2002 and 2010 were included, AP-PA (n=31), 3D-conformal (n=25) and IMRT (n=31), all 45 Gy in 25 fractions. Concurrent chemotherapy: 5FU/leucovorin (n=4), capecitabine (n=37), and capecitabine/cisplatin (n=46). Median follow-up time was 4.7 years (range 0.2-8). With IMRT, the mean dose to the left kidney was significantly lower. Left kidney function decreased progressively in the total study population, however with IMRT this occurred at a lower rate. A dose-effect relationship was present between mean dose to the left kidney and the left kidney function. GFR decreased only moderately in time, which was not different between techniques. Six patients developed hypertension, of whom none in the IMRT group. CONCLUSIONS: This study confirms progressive late nephrotoxicity in patients treated with postoperative chemoradiotherapy by different techniques for gastric cancer. Nephrotoxicity was less severe with IMRT and should be considered the preferred technique.
OBJECTIVE: This observational study compares the effect of different radiotherapy techniques on late nephrotoxicity after postoperative chemoradiotherapy for gastric cancer. PATIENTS AND METHODS: Dosimetric parameters were compared between AP-PA, 3D-conformal and IMRT techniques. Renal function was measured by (99m)Tc-MAG-3 renography, glomerular filtration rate (GFR) and the development of hypertension. Mixed effects models were used to compare renal function over time. RESULTS: Eighty-seven patients treated between 2002 and 2010 were included, AP-PA (n=31), 3D-conformal (n=25) and IMRT (n=31), all 45 Gy in 25 fractions. Concurrent chemotherapy: 5FU/leucovorin (n=4), capecitabine (n=37), and capecitabine/cisplatin (n=46). Median follow-up time was 4.7 years (range 0.2-8). With IMRT, the mean dose to the left kidney was significantly lower. Left kidney function decreased progressively in the total study population, however with IMRT this occurred at a lower rate. A dose-effect relationship was present between mean dose to the left kidney and the left kidney function. GFR decreased only moderately in time, which was not different between techniques. Six patients developed hypertension, of whom none in the IMRT group. CONCLUSIONS: This study confirms progressive late nephrotoxicity in patients treated with postoperative chemoradiotherapy by different techniques for gastric cancer. Nephrotoxicity was less severe with IMRT and should be considered the preferred technique.
Authors: Alison K Yoder; Jillian R Gunther; Sarah A Milgrom; Mary Pham; Donald Hancock; Kelli McSpadden; John Garcia; Dragan Mirkovic; Bouthaina S Dabaja; Chelsea C Pinnix Journal: Pract Radiat Oncol Date: 2019-01-29
Authors: Alison K Yoder; Jillian R Gunther; Sarah A Milgrom; Dragan Mirkovic; Loretta Nastoupil; Sattva Neelapu; Michelle Fanale; Nathan Fowler; Jason Westin; Hun Ju Lee; M Alma Rodriguez; Swaminathan P Iyer; Luis Fayad; Yago L Nieto; Chitra Hosing; Sairah Ahmed; L Jeffrey Medeiros; Joseph D Khoury; Naveen Garg; Behrang Amini; Bouthaina S Dabaja; Chelsea C Pinnix Journal: Clin Lymphoma Myeloma Leuk Date: 2018-09-10
Authors: X Wang; D B Zhao; L Yang; Y Chi; Y Tang; N Li; S L Wang; Y W Song; Y P Liu; W Y Liu; H Ren; T Zhang; J Y Wang; X S Chen; H Fang; W H Wang; Y X Li; J Jin Journal: Br J Cancer Date: 2017-12-12 Impact factor: 7.640