The Effect of Chemoradiotherapy at Gastric Cancer on Pancreatic Enzymes and Pancreas Volume.

Abstract

Post-operative chemoradiotherapy is one of the therapeutic approaches for operated gastric cancer. During radiotherapy planning, pancreas has not been accepted as a critical organ until now, thus toxicity to pancreas has not been considered. In our prospective study, serum pancreatic enzyme levels and pancreatic volume after RT is investigated. Seventy-one patients with gastric cancer were evaluated adjuvant chemoradiotherapy. Mean pancreas volume, mean pancreas radiotherapy dose and V5, V10, V20 and V40 values were calculated. Fasting blood glucose, insulin, amylase and glycosylated hemoglobin levels were evaluated before radiotherapy and re-evaluated at the end of radiotherapy, at 1th, 3rd, 6th and 12th months after radiotherapy. Pancreas volume was evaluated before radiotherapy and re-evaluated at 12th month after radiotherapy. Before the initiation, after the first session and at the 1th, 3th, 6th and 12th months of radiotherapy, difference between serum Fasting blood glucose (p= 0.179), insulin (p= 0.296), HbA1c (p= 0.468) and amylase levels (p= 0.069) levels were not statistically significant but there is statistically significant decrease in pancreatic volume after treatment (p= 0.002). Postoperative chemoradiotherapy is able to prolong survival and decrease recurrence in operated gastric cancer patients. In our prospective study, we could not identify any statistically significant finding related to pancreatic toxicity or its presentation on biochemical parameters except pancreas atrophy in one-year period. Although, there was not any self-reported diabetes mellitus at early period it, follow-up needed for late toxicity. Keywords: Chemoradiotherapy, Gastric cancer, Pancreatic enzymes, Pancreas volume ÖZET Mide Kanserinde Kemoradyoterapinin Pankreas Hacmi ve Pankreas Enzimleri Üzerine EtkisiPost-operatif kemoradyoterapi, ameliyat edilen mide kanseri için terapötik yaklaşımlardan biridir. Radyoterapi planlaması sırasında şimdiye kadar pankreas kritik bir organ olarak kabul edilmemiştir, bu nedenle pankreas toksisitesi dikkate alınmamıştır. Prospektif çalışmamızda, radyoterapi sonrası serum pankreatik enzim düzeyleri ve pankreas hacmi araştırılmıştır. Adjuvan kemoradyoterapi uygulanan 71 mide kanserli hasta değerlendirildi. Ortalama pankreas hacmi, ortalama pankreas radyoterapi dozu ve V5, V10, V20 ve V40 değerleri hesaplandı. Açlık kan şekeri, insülin, amilaz ve glikolize hemoglobin düzeyleri radyoterapi öncesi değerlendirildi ve radyoterapi bitiminde, radyoterapiden sonra 1, 3, 6. ve 12. aylarda yeniden değerlendirildi. Pankreas hacmi radyoterapi öncesi değerlendirildi ve radyoterapiden sonraki 12. ayda yeniden değerlendirildi. Radyoterapi öncesi, radyoterapi bitiminde, radyoterapiden sonra 1, 3, 6. ve 12. aylarda serum açlık kan glikozu (p= 0.179), insülin (p= 0.296), HbA1c (p= 0.468) ve amilaz düzeyleri istatistiksel olarak anlamlı değildi (p= 0.069), ancak tedavi sonrası pankreas hacminde istatistiksel olarak anlamlı bir azalma vardı (p= 0.002). Postoperatif kemoradyoterapi ameliyat edilen mide...

Gastrik Tümörlerde Radyasyona Bağlı Pankreatik ve Hematolojik Hasarlanma

“…There is a wide range of pancreatic volume values from 26.14 to 153.12 cm 3 in the literature. [8,9] A study analyzing the effect of CRT at GC on pancreatic enzymes and pancreas volume measured the mean pancreatic volume as 55.79±21.71 cm 3 , as 55.59±22.19 cm 3 (26.14-153.12) in 45 Gy radiation and 56.92±22.59 cm 3 (30.60-104.43) in ≥50.40 Gy radiation [9]. In the present study, the mean pancreatic volume was 74.09±16.01 cm 3 and V40 of the pancreas had received 98.47±6.17.…”

“…The acinar cells of the pancreas are comparatively sensitive to radiation and hence are prone to abdominal radiation toxicity in RT of gastric malignancies. [9] Chronic pancreatitis was reported even years after abdominal RT. [15] Kandaz et al [9] found that the exposure of the pancreas to a radiation dose of 5 Gy (V5) decreased the plasma amylase levels, associated with decreased risk of GC .…”

“…[9] Chronic pancreatitis was reported even years after abdominal RT. [15] Kandaz et al [9] found that the exposure of the pancreas to a radiation dose of 5 Gy (V5) decreased the plasma amylase levels, associated with decreased risk of GC . In our study, the radiation dose of 45 Gy on the gastric tumor may probably affect the acinar cells of the pancreas, which are sensitive to radiation-induced injury more than islet cells, resulting in a significant decrease in amylase levels right after RT.…”

“…[6,7] As the pancreas is a radiation-sensitive organ, it tends to lose its volume and function after radiation exposure; however, it is not yet considered as an organ at risk for radiation treatment planning, and there is little information about the pancreas even though it is near to the stomach, may be affected from the RT doses, resulting in the alteration of the pancreatic function. [8,9] Therefore, in the present study, we aimed to demonstrate the radiation-induced pancreatic and hematologic injury in three-dimensional conformal radiation therapy (3D-CRT) for gastric tumors by examining the data of patients who were referred to our clinic with GC and underwent CRT retrospectively, comparing the pancreatic exocrine enzymes and blood parameters between pre-and post-RT. The other aim was to find out the correlation between the alterations in pancreatic enzyme concentrations and the pancreatic dose distribution.…”