Analysis of Clinical and Dosimetric Factors Associated With Change in Renal Function in Patients With Gastrointestinal Malignancies After Chemoradiation to the Abdomen

May, Kilian Salerno; Chandrasekhar, Rameela; Wilding, Gregory E.; Iyer, Renuka; Wang, Wen; Flaherty, L.; Russo, R; Fakih, Marwan; Kuvshinoff, Boris W.; Gibbs, John F.; Javle, Milind; Yang, Gary

doi:10.1016/j.ijrobp.2009.03.002

Cited by 10 publications

(7 citation statements)

References 19 publications

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“…Renal toxicity is a serious complication of radiotherapy, as studies reveal gradual worsening of renal function of up to 50% at 18 months post-treatment. Factors contributing to renal impairment include the V20 of the left kidney (percentage volume of left kidney receiving more than 20 Gy) and mean left kidney dose, and pre-radiotherapy creatinine clearance [20,21]. The results of the present study did not show significant clinically manifested renal complications; however, among the three patients with renal impairment, imaging did reveal atrophic left kidneys, which is clearly a radiation-induced effect.…”

Section: Secondary Malignancycontrasting

confidence: 48%

Adjuvant chemoradiation for resected gastric cancer: a 10-year experience

Chang

Law

et al. 2011

Gastric Cancer

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Background The Intergroup 0116 study demonstrated that concurrent chemoradiation improved overall survival (OS) in resected gastric cancer. However, there are few reports focusing on late toxicity and factors governing prognosis. This study aimed to determine these two important aspects for employing this regimen. Methods Patients with resected gastric cancer stage IB to IV (M0) disease, treated between July 1998 and December 2007, were analyzed. The majority of the patients were treated using 5 cycles of 5-fluorouracil (5FU)/leucovorin chemotherapy with 45 Gy/25 fractions radiotherapy concurrent with cycles 2 and 3, as per the Intergroup 0116 study. Results We treated 120 patients (107 standard protocol, 13 with concurrent 5FU alone), and 14% had a close or positive margin. Median age was 59 years (35-79 years). Acute toxicity C grade 3 was seen in 66% of all patients (hematological 61%, stomatitis 3%, diarrhea 6%, vomiting 2%). Median follow-up was 33 months (range 6-125 months). Five-year OS and relapse-free survival were 51 and 54%, respectively. On multivariate analysis, surgical margin status, stage of the disease, and radiotherapy with computed tomography (CT) planning were important prognostic factors. Anemia and gastritis were the two most frequently occurring late complications, though they were usually mild and asymptomatic. Clinically significant renal impairment was uncommon. Other rare complications included intestinal obstruction, malabsorption, hypertension, and secondary malignancy. Conclusions Postoperative chemoradiation is safe and late toxicity is usually mild in extent. Results were comparable to the Intergroup 0116 study. R0 resection is of utmost importance and radiotherapy should best be delivered by conformal techniques.

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Section: Secondary Malignancycontrasting

confidence: 48%

Adjuvant chemoradiation for resected gastric cancer: a 10-year experience

Chang

Law

et al. 2011

Gastric Cancer

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“…These data are less helpful for late toxicity risk estimation in the setting of modern RT planning and treatment. In a prior investigation of this patient cohort, significant decline in CrCl and increase in creatinine was seen after chemoradiotherapy for abdominal malignancies (10). Correlation was observed between pre-RT CrCl, V 10 , and MKD and subsequent development of grade $2 renal toxicity, as defined by the Radiation Therapy Oncology Group/European Organization for Research and Treatment of Cancer late radiation morbidity scoring schema (30).…”

Section: Discussionmentioning

confidence: 69%

“…The dose tolerance limits for the kidneys are lower than other surrounding organs in the abdomen (11,15). The literature available on renal tolerance and late toxicity has focused primarily on biochemical endpoints of renal function, such as creatinine and CrCl (4,7,8,10). Publications on renal atrophy after chemoradiotherapy for GI malignancies are scarce.…”

Section: Discussionmentioning

confidence: 99%

“…Subclinical complications have a shorter latency period than clinical presentation of symptomatic nephropathy (1)(2)(3). Presymptomatic toxicity can be detected by renal functional decline, measured by biochemical endpoints such as creatinine and creatinine clearance (CrCl), and decrease in kidney size (KS) (4,(8)(9)(10). Much of the data from which renal tolerances have been based comes from bilateral kidney irradiation in the setting of total-body and whole-abdominal irradiation (6,7).…”

Section: Introductionmentioning

confidence: 99%

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Renal Atrophy Secondary to Chemoradiotherapy of Abdominal Malignancies

Yang¹,

May²,

Iyer³

et al. 2010

International Journal of Radiation Oncology*Biology*Physics

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“…47,53 The main complication reported when there is an excess dose is decrease in renal function when the kidney's dose is greater than its tolerance (B). 54 Assessments of the dose received by irradiated organ volume show the tolerance thresholds below which there is no toxicity (B) [55][56][57][58][59][60][61] (D). 62 Several prospective studies associate dosimetric parameters and toxicity of the organs at risk, showing lower toxicity with conformal therapy compared to conventional radiotherapy (B) 20,63,64 (C) 65 (D).…”

Section: Pancreatic and Biliary Tract Tumorsmentioning

confidence: 99%