TY - JOUR
T1 - IMRT limits nephrotoxicity after chemoradiotherapy for gastric cancer
AU - Trip, Anouk Kirsten
AU - Nijkamp, Jasper
AU - Van Tinteren, Harm
AU - Cats, Annemieke
AU - Boot, Henk
AU - Jansen, Edwin Petrus Marianus
AU - Verheij, Marcel
N1 - Publisher Copyright:
©2014 Elsevier Ireland Ltd. All rights reserved. Radiotherapy and Oncology.
PY - 2014/8/1
Y1 - 2014/8/1
N2 - Objective This observational study compares the effect of different radiotherapy techniques on late nephrotoxicity after postoperative chemoradiotherapy for gastric cancer.Patients and methods Dosimetric parameters were compared between AP-PA, 3D-conformal and IMRT techniques. Renal function was measured by 99mTc-MAG-3 renography, glomerular filtration rate (GFR) and the development of hypertension. Mixed effects models were used to compare renal function over time.Results Eighty-seven patients treated between 2002 and 2010 were included, AP-PA (n = 31), 3D-conformal (n = 25) and IMRT (n = 31), all 45 Gy in 25 fractions. Concurrent chemotherapy: 5FU/leucovorin (n = 4), capecitabine (n = 37), and capecitabine/cisplatin (n = 46). Median follow-up time was 4.7 years (range 0.2-8). With IMRT, the mean dose to the left kidney was significantly lower. Left kidney function decreased progressively in the total study population, however with IMRT this occurred at a lower rate. A dose-effect relationship was present between mean dose to the left kidney and the left kidney function. GFR decreased only moderately in time, which was not different between techniques. Six patients developed hypertension, of whom none in the IMRT group.Conclusions This study confirms progressive late nephrotoxicity in patients treated with postoperative chemoradiotherapy by different techniques for gastric cancer. Nephrotoxicity was less severe with IMRT and should be considered the preferred technique.
AB - Objective This observational study compares the effect of different radiotherapy techniques on late nephrotoxicity after postoperative chemoradiotherapy for gastric cancer.Patients and methods Dosimetric parameters were compared between AP-PA, 3D-conformal and IMRT techniques. Renal function was measured by 99mTc-MAG-3 renography, glomerular filtration rate (GFR) and the development of hypertension. Mixed effects models were used to compare renal function over time.Results Eighty-seven patients treated between 2002 and 2010 were included, AP-PA (n = 31), 3D-conformal (n = 25) and IMRT (n = 31), all 45 Gy in 25 fractions. Concurrent chemotherapy: 5FU/leucovorin (n = 4), capecitabine (n = 37), and capecitabine/cisplatin (n = 46). Median follow-up time was 4.7 years (range 0.2-8). With IMRT, the mean dose to the left kidney was significantly lower. Left kidney function decreased progressively in the total study population, however with IMRT this occurred at a lower rate. A dose-effect relationship was present between mean dose to the left kidney and the left kidney function. GFR decreased only moderately in time, which was not different between techniques. Six patients developed hypertension, of whom none in the IMRT group.Conclusions This study confirms progressive late nephrotoxicity in patients treated with postoperative chemoradiotherapy by different techniques for gastric cancer. Nephrotoxicity was less severe with IMRT and should be considered the preferred technique.
KW - 3D-conformal
KW - AP-PA
KW - Gastric cancer
KW - IMRT
KW - Nephrotoxicity
KW - Postoperative chemoradiotherapy
UR - http://www.scopus.com/inward/record.url?scp=84910141323&partnerID=8YFLogxK
U2 - 10.1016/j.radonc.2015.03.009
DO - 10.1016/j.radonc.2015.03.009
M3 - Article
C2 - 25241995
AN - SCOPUS:84910141323
SN - 0167-8140
VL - 112
SP - 289
EP - 294
JO - Radiotherapy and Oncology
JF - Radiotherapy and Oncology
IS - 2
ER -