Impact of Radiotherapy on Kidney Function among Patients Who Received Adjuvant Treatment for Gastric Cancer: Logistic and Linear Regression Analyses

Abstract

We investigated the incidence of renal function impairment after adjuvant treatment for gastric cancer and analyzed the impact of radiotherapy on estimated glomerular filtration rate (eGFR) five years after gastric surgery. We reviewed the medical records of 1490 patients with stomach cancer who underwent curative surgery and adjuvant treatment for gastric cancer. Finally, we included 663 patients who were followed up for ≥5 years without disease recurrence and whose baseline eGFR was ≥60 mL/min/1.73 m2. Logistic and linear regression analyses were performed to determine independent factors associated with the five-year eGFR. A total of 13 (2.0%) patients developed renal function impairment (five-year eGFR <60 mL/min/1.73 m2). In logistic regression analysis, the baseline eGFR was identified as a prognostic factor for renal function impairment (odds ratio (OR), 0.878; 95% confidence interval (CI), 0.831–0.927; p < 0.001), but radiotherapy was not (OR, 1.130; 95% CI, 0.366–3.491; p = 0.832). In linear regression analysis, age (B = −0.350, p < 0.001), baseline eGFR (B = 0.576, p < 0.001), cisplatin (B = −2.056, p = 0.010), and radiotherapy (B = −2.628, p < 0.001) were predictive variables for the five-year eGFR. Among patients who received adjuvant radiotherapy, age (B = −0.277, p < 0.001), hypertension (B = −4.986, p = 0.004), baseline eGFR (B = 0.665, p < 0.001), and volume of the kidneys receiving ≥20 Gy (B = −0.209, p = 0.012) were predictive variables for the five-year eGFR. Development of renal function impairment after adjuvant treatment for gastric cancer was rare among patients with normal baseline kidney function. While radiotherapy was negatively associated with the five-year eGFR, its impact would have been minimal if the kidneys were properly shielded. Further studies are needed to confirm the impact of radiotherapy in patients with poor kidney function.

Higher Dose to Organs at Risk: The Unintended Consequences of Intravenous Contrast Use in Computed Tomography Simulation for Cervical Cancer

“…36 In addition, a recent study including 663 patients with stomach cancer demonstrated that the kidney V20 was an important predictive factor for renal insufficiency and that maintaining a low kidney V20 could minimize the impact of radiation on the five-year eGFR. 37 Notably, there was a significant difference in the V20 to the right kidney between the two treatment plans in our study. There is minimal evidence of increased toxicities in the duodenum or renal toxicities from these small changes in dosimetry.…”

A modified delineation method of para‐aortic nodal clinical target volume in patients with locally advanced cervical cancer

“…Additionally, in our published study of 20 patients with locally advanced cervical cancer who received prophylactic EFI using a similar delineation method of para‐aortic nodal CTV‐M, no patients experienced PALN recurrence at a median follow‐up of 26.5 months, and 5 (25%) patients experienced grade 3 acute gastrointestinal toxicity and 1 (5%) patient experienced grade 3 chronic gastrointestinal toxicity 25 . For the bilateral kidneys, published studies have found that the D mean and V 20Gy were associated with renal toxicity in partial‐body radiotherapy of gynecological cancers and abdominal cancers 28,29 . Noteworthy, there was a significant difference in the D mean to the bilateral kidneys between CTV‐D and CTV‐M ( p = 0.011).…”

“… 25 For the bilateral kidneys, published studies have found that the D mean and V 20Gy were associated with renal toxicity in partial‐body radiotherapy of gynecological cancers and abdominal cancers. 28 , 29 Noteworthy, there was a significant difference in the D mean to the bilateral kidneys between CTV‐D and CTV‐M ( p = 0.011). For the small bowel, published studies have found that the V 45Gy was associated with small bowel toxicity in radiotherapy of gynecological cancers.…”

Low rate of severe-end-stage kidney disease after SABR for localised primary kidney cancer

“…However, similar findings were reported in prior radiotherapy studies as well. In one study, Park et al [ 22 ] found only baseline eGFR to be the sole prognostic factor for renal function impairment in their multivariable logistic regression analysis when evaluating the risk factors for renal function impairment in patients with gastric cancer treated with surgery and adjuvant radiotherapy.…”