Radiation-induced injury of the exocrine pancreas after chemoradiotherapy for gastric cancer

Wydmański, Jerzy; Polanowski, Paweł; Tukiendorf, Andrzej; Masłyk, Barbara

doi:10.1016/j.radonc.2015.11.033

Cited by 25 publications

(22 citation statements)

References 19 publications

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“…However, no systematic studies have provided data about the radiosensitivity of human pancreatic tissue or radiation-induced pancreatic insufficiency. The strong structural similarity between pancreatic and salivary glands suggests that radiation-associated injury of the pancreas may be similar to that of the salivary gland [ 19 ]. The high radiation sensitivity of salivary tissue leads to reproductive death of acinar progenitor cells, even though secretory cells in salivary glands have a slow turnover [ 20 ].…”

Section: Discussionmentioning

confidence: 99%

Total body irradiation and iron chelation treatment are associated with pancreatic injury following pediatric hematopoietic stem cell transplantation

et al. 2018

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Whereas many studies have addressed the risk of organ dysfunction following hematopoietic stem cell transplantation (HSCT), little is known about pancreatic susceptibility in this setting. We aimed to investigate the effect of iron overload (IO) and total body irradiation (TBI) on pancreatic function of children undergoing HSCT.We retrospectively evaluated children admitted between 2012-2016 fulfilling the following criteria: normal pancreatic iron concentration (PIC), regular pancreatic function before HSCT, availability of abdominal magnetic resonance imaging with gradient-recalled-echo sequences and a full set of biochemical markers of IO and pancreatic function performed before HSCT and at discharge. We divided the patients according to the use of TBI or myeloablative chemotherapy (MCHT) in the conditioning regimen. All patients with severe IO or moderate IO with a high risk of engraftment delay or transplantation-related complications underwent chelation therapy with deferoxamine (DFO) from the first day of conditioning to discharge.63 patients had a HSCT in the study period, 13 did not fulfill the inclusion criteria; 50 (25 in each group) are included in the analysis, and did not show differences at baseline evaluation. At follow up testing the TBI group showed a significantly higher PIC (107,8±100,3 μmol/g vs 28,4±37,9 in MCHT group, p<0,0001). In the TBI group the patients who had DFO treatment had higher PIC (223,2±48,8 μmol/g vs 55,7±10,5 without DFO treatment, p<0,0001), and all patients having PIC >100 μmol/g at follow up had DFO-based chelation therapy, versus 26% of those with lower PIC (p<0,0001). The number of patients presenting exocrine pancreatic dysfunctions one month after transplantation was significantly higher in the TBI group (48% vs 4%; p<0.0001). The mean pancreatic volume reduction was significantly greater in the TBI group (39,1% vs 0,9% in the MCHT group; p<0,05), and was significantly worse on those who received DFO therapy.Based on our data, we suggest that TBI is detrimental for pancreatic functions, and speculate that DFO may contribute to the rapid pancreatic IO observed in these patients.

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Section: Discussionmentioning

confidence: 99%

Total body irradiation and iron chelation treatment are associated with pancreatic injury following pediatric hematopoietic stem cell transplantation

et al. 2018

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“…A recent clinical study revealed possible compromised serum amylase/lipase profiles due to radiation. However, it may not be possible to generalize those results, since the data in that study was confined to the amylase/lipase profiles, and the radiation dose distributions in the abdominal organs were not specified at all [ 11 ]. Consequently, at this time, the most reliable parameter for PRE is dosimetric data.…”

Section: Discussionmentioning

confidence: 99%

“…This radiation vulnerability can be explained by the presence of the pancreas, located at the center of the upper abdomen [ 7 – 11 ]. From this perspective, pancreatic radiation effect (PRE) needs to be considered in terms of inter-organ interaction.…”

Section: Introductionmentioning

confidence: 99%

Pancreatic radiation effect in apoptosis-related rectal radiation toxicity

You

Cho

Sohn

et al. 2018

Journal of Radiation Research

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Pancreatic radiation effect (PRE) can be a component of gastrointestinal tract (GIT) radiotoxicity. This inter-organ correlation between the GIT and the pancreas was assessed through a rat model. Separate local irradiation to the abdomen and the pelvis was applied concurrently for 8-week-old male Sprague Dawley rats. Abdominal irradiation was categorized into pancreatic shield (PS) and non-pancreatic shield (NPS) irradiation. After 5 Gy and 15 Gy irradiation, the rectal mucosa was analyzed at the first week (early phase, Ep) and the 14th week (late phase, Lp). A slow gain in body weight was observed initially, particularly in the NPS group receiving a 15 Gy dose (P < 0.001). The large number of apoptotic bodies after 15 Gy at Ep decreased at Lp. At Ep for the 5-Gy group, the NPS group revealed more fibrotic change than the PS group (P = 0.002). Cleaved caspase-3 (CCP3) expression was greater at Lp, and the Ep–Lp increase was prominent in the NPS-15-Gy group (P = 0.010). At Lp, for 15 Gy irradiation, CCP3 was expressed more in the NPS group than in the PS group (P = 0.032). Despite no direct toxicity difference between the PS and NPS groups, small changes in parameters such as fibrosis or CCP3 expression suggest that pancreatic shielding does have an effect on the radiation response in the rectal mucosa, which suggests a need for a multi-organ effect-based approach in GIT radiotoxicity assessment.

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“…They concluded that abdominal radiotherapy should be added to the list of causes of chronic pancreatitis and vascular process should responsible for the hysiopathology of post- radiation chronic pancreatitis. The research by Jerzy Wydmanski [13] evaluated the radiation-induced injury of the exocrine pancreas among 127 gastric cancer patients with a total dose of 45 Gy given in 25 fractions. Lipase and a-amylase deficiencies were found in 48.2% and 19.7% patients respectively.…”

Section: Tablementioning

confidence: 99%

“…Radiation-induced malnutrition [11,12] is a common side effect of radiation therapy, and many patients suffer a acute or chronic gastrointestinal symptoms as a consequence. Recently, emerging studies have demonstrated that radiation can damage pancreas exocrine [13] and endocrine [14] function which play an important role in food digest and nutrition absorption. Therefore, we speculated that the irradiated pancreas might play an important role in sarcopenia for gastric cancer patients after adjuvant CRT.…”

Section: Introductionmentioning

confidence: 99%

Predictive value of pancreatic dose-volume metrics on sarcopenia rate in gastric cancer patients treated with adjuvant chemoradiotherapy

Jiang

Dai

et al. 2019

Clinical Nutrition

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Radiation-induced injury of the exocrine pancreas after chemoradiotherapy for gastric cancer

Cited by 25 publications

References 19 publications

Total body irradiation and iron chelation treatment are associated with pancreatic injury following pediatric hematopoietic stem cell transplantation

Total body irradiation and iron chelation treatment are associated with pancreatic injury following pediatric hematopoietic stem cell transplantation

Pancreatic radiation effect in apoptosis-related rectal radiation toxicity

Predictive value of pancreatic dose-volume metrics on sarcopenia rate in gastric cancer patients treated with adjuvant chemoradiotherapy

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