title: Late renal function following whole abdominal irradiation.
abstract: Sixty patients treated with whole abdominal radiotherapy who had remained disease-free since completion of treatment participated in a study to assess the late clinical and biochemical effects of bilateral renal irradiation. Minimum follow-up was 5 years with a maximum of 20 years and a median of 9 years. Fifty-two patients in the study group were treated for primary ovarian cancer. Seven had non-Hodgkins lymphoma arising in the gastrointestinal tract and one patient had a carcinoid tumour arising in small bowel. None of the patients received chemotherapy. Abdominal radiation was given using an open beam technique to a mean dose of 22.92 Gy (range 6.68-27.54 Gy) in 1.02 to 1.25 Gy fractions treated once daily. Posterior kidney shields were used in order to limit the renal dose to < 20 Gy. Mean radiation dose to both kidneys (retrospectively calculated) was 19.28 Gy (range 6.68-22.99 Gy). Patients ranged in age from 32-81 years with a median of 61 years. No patient had clinical evidence of renal impairment. Nine patients were hypertensive prior to radiotherapy and a further five patients became hypertensive after treatment. Serum creatinine values ranged from 44-123 mumol/l, with a mean of 87 mumol/l. Creatinine clearance ranged from 0.61-2.38 ml/s (mean 1.28 ml/s). Tubular function tests revealed one borderline high 24-h protein excretion and normal 24-h phosphorous and uric acid. Using a multiple linear regression analysis with creatinine clearance as the endpoint, age was the only significant variable (P < 0.00001) and renal dose and interval from treatment were not independently significant. There was no evidence of late renal toxicity more than 5 years after whole abdominal radiotherapy delivered with this technique and dose/fractionation schedule, and using the clinical and biochemical endpoints assessed in this study.
authors.affiliation: Department of Radiation Oncology, Princess Margaret Hospital, Toronto, Canada.
authors.forename: C
authors.initials: C
authors.lastname: Irwin
authors.forename: A
authors.initials: A
authors.lastname: Fyles
authors.forename: C S
authors.initials: CS
authors.lastname: Wong
authors.forename: C M
authors.initials: CM
authors.lastname: Cheung
authors.forename: Y
authors.initials: Y
authors.lastname: Zhu
mesh_terms: D005260:Female; D005500:Follow-Up Studies; D005770:Gastrointestinal Neoplasms / Q000532:radiotherapy*; D006801:Humans; D007668:Kidney / Q000528:radiation effects*; D007677:Kidney Function Tests; D008228:Lymphoma, Non-Hodgkin / Q000532:radiotherapy*; D008297:Male; D008875:Middle Aged; D010051:Ovarian Neoplasms / Q000532:radiotherapy*; D011832:Radiation Injuries / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control; D011835:Radiation Protection; D011879:Radiotherapy Dosage; D013997:Time Factors