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Prospective study on late renal toxicity following postoperative chemoradiotherapy in gastric cancer.
Jansen, Edwin P M Saunders, Mark P Boot, Henk Oppedijk, Vera Dubbelman, Ria Porritt, Bridget Cats, Annemieke Stroom, Joep Valdés Olmos, Renato Bartelink, Harry
Jansen, Edwin P M
Saunders, Mark P
Boot, Henk
Oppedijk, Vera
Dubbelman, Ria
Porritt, Bridget
Cats, Annemieke
Stroom, Joep
Valdés Olmos, Renato
Bartelink, Harry
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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, 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.
Description
Date
2007-03-01
Publisher
Collections
Keywords
Stomach Cancer
Type
Article
Citation
Prospective study on late renal toxicity following postoperative chemoradiotherapy in gastric cancer. 2007, 67 (3):781-5 Int. J. Radiat. Oncol. Biol. Phys.