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

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    Authors
    Jansen, Edwin P M
    Saunders, Mark P
    Boot, Henk
    Oppedijk, Vera
    Dubbelman, Ria
    Porritt, Bridget
    Cats, Annemieke
    Stroom, Joep
    Valdés Olmos, Renato
    Bartelink, Harry
    Verheij, Marcel
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    Affiliation
    Department of Radiotherapy, The Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands. epm.jansen@nki.nl
    Issue Date
    2007-03-01
    
    Metadata
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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.
    Citation
    Prospective study on late renal toxicity following postoperative chemoradiotherapy in gastric cancer. 2007, 67 (3):781-5 Int. J. Radiat. Oncol. Biol. Phys.
    Journal
    International Journal of Radiation Oncology, Biology, Physics
    URI
    http://hdl.handle.net/10541/71039
    DOI
    10.1016/j.ijrobp.2006.09.012
    PubMed ID
    17157445
    Type
    Article
    Language
    en
    ISSN
    0360-3016
    ae974a485f413a2113503eed53cd6c53
    10.1016/j.ijrobp.2006.09.012
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