Risk of endocrine pancreatic insufficiency in patients receiving adjuvant chemoradiation for resected gastric cancer

Gemici, Cengiz; Sargın, Mehmet; Uygur-Bayramiçli, Oya; Mayadağlı, Alpaslan; Yaprak, Gökhan; Dabak, Reşat; Koçak, Mihriban

doi:10.1016/j.radonc.2013.04.013

Cited by 29 publications

(26 citation statements)

References 30 publications

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“…Third, some of our patients preoperatively received anticancer agents for malignant diseases. Although the relative beta-cell area was not different between these patients and those who had not been treated with anticancer agents, we could not completely exclude the effect of chemotherapy on pancreatic histology or glucose tolerance [38]. While we admit the above limitations using operative pancreatic samples, the most important merit of this study is the thorough evaluation of the pathophysiological condition together with detailed histopathological analysis of the pancreas.…”

Section: Discussionmentioning

confidence: 90%

Increment of serum C-peptide measured by glucagon test closely correlates with human relative beta-cell area

et al. 2015

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Section: Discussionmentioning

confidence: 90%

Increment of serum C-peptide measured by glucagon test closely correlates with human relative beta-cell area

et al. 2015

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“…Abdominal irradiation as in the adjuvant treatment of patients with operated gastric cancer may result in decline in BMD and osteoporosis. This is an indirect effect which results from malabsorption of calcium and vitamin D and other micronutrients related with bone metabolism due to radiation induced late tissue toxicity on remnant stomach, small intestine and pancreatic tissue [ 16 – 18 ]. Beside this indirect effect of abdominal irradiation on bone tissue, there is also a direct bone toxicity.…”

Section: Introductionmentioning

confidence: 99%

Osteoporosis development and vertebral fractures after abdominal irradiation in patients with gastric cancer

et al. 2018

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BackgroundDecrease in bone mineral density, osteoporosis development, bone toxicity and resulting insufficiency fractures as late effect of radiotherapy are not well known. Osteoporosis development related to radiotherapy has not been investigated properly and insufficiency fractures are rarely reported for vertebral bones.MethodsNinety-seven patients with gastric adenocarcinoma were evaluated for adjuvant treatment after surgery. While 73 out of 97 patients treated with adjuvant chemoradiotherapy comprised the study group, 24 out of 97 patients with early stage disease without need of adjuvant treatment comprised the control group. Bone mineral densities (BMD) of lumbar spine and femoral neck were measured by dual energy x-ray absorptiometry after surgery, and one year later in both groups.ResultsThere was statistically significant decline in BMDs after one year in each group itself, however the decline in BMDs of the patients in the irradiated group was more pronounced when compared with the patients in the control group; p values were 0.02 for the decline in BMDs of lumbar spine, and 0.01 for femoral neck respectively. Insufficiency fractures were observed only in the irradiated patients (7 out of 73 patients) with a cumulative incidence of 9.6%.ConclusionsAbdominal irradiation as in the adjuvant treatment of gastric cancer results in decrease in BMD and osteoporosis. Insufficiency fracture risk in the radiation exposed vertabral bones is increased. Calcium and vitamin D replacement and other measures for prevention of osteoporosis and insufficiency fractures should be considered after abdominal irradiation.

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“…The radiotoxicity of one organ can be influenced by the status of simultaneously irradiated adjacent other organs [ 7 , 8 , 14 ]. PRE can contribute to GIT toxicity [ 8 , 10 ]. However, there have not been sufficient follow-up studies investigating this due to the technical difficulty in separately irradiating each organ in the abdomen.…”

Section: Discussionmentioning

confidence: 99%

Pancreatic radiation effect in apoptosis-related rectal radiation toxicity

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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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Risk of endocrine pancreatic insufficiency in patients receiving adjuvant chemoradiation for resected gastric cancer

Cited by 29 publications

References 30 publications

Increment of serum C-peptide measured by glucagon test closely correlates with human relative beta-cell area

Increment of serum C-peptide measured by glucagon test closely correlates with human relative beta-cell area

Osteoporosis development and vertebral fractures after abdominal irradiation in patients with gastric cancer

Pancreatic radiation effect in apoptosis-related rectal radiation toxicity

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