title: Renal dysfunction after total-body irradiation. Significance of selective renal shielding blocks.
abstract: OBJECTIVE
  A retrospective analysis was conducted on the outcome of total-body irradiation (TBI) followed by bone marrow transplantation (BMT) on leukemia patients. Also studied was the risk of renal dysfunction after TBI/BMT with or without the use of selective renal shielding blocks.
  
  
  METHODS
  The cases of 109 leukemia patients who received TBI as a component of the conditioning regimen for their BMT were reviewed. They received 12 Gy of TBI in six fractions over 3 consecutive days. Doses to eyes and lungs were reduced to 7 Gy and 8 Gy, respectively, by customized organ shielding blocks. After March 1999, renal shielding blocks were used to constrain the renal dose to 10 Gy. The patients were followed for a median period of 16.6 months (range: 0.3-180.1 months).
  
  
  RESULTS
  The 2-year and 5-year overall survival rates were 55.4% and 43.2%, respectively. Renal dysfunction-free rates were different between those with and without renal shielding blocks: 100% and 78.5%, respectively, at 2 years. Overall survivals were not significantly different among these patients: 60.4% and 52.9%, respectively, at 2 years in patients with and without renal shielding blocks (p = 0.53).
  
  
  CONCLUSIONS
  The use of selective renal shielding blocks provided evidence for reducing radiation-induced renal toxicities without decreasing the overall survival rate.
authors.affiliation: Department of Radiation Oncology, Tokyo Metropolitan Komagome Hospital, Tokyo, Japan. igaki-tky@umin.ac.jp
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Igaki
authors.forename: Katsuyuki
authors.initials: K
authors.lastname: Karasawa
authors.forename: Hisashi
authors.initials: H
authors.lastname: Sakamaki
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Saito
authors.forename: Keiichi
authors.initials: K
authors.lastname: Nakagawa
authors.forename: Kuni
authors.initials: K
authors.lastname: Ohtomo
authors.forename: Yoshiaki
authors.initials: Y
authors.lastname: Tanaka
mesh_terms: D000293:Adolescent; D000328:Adult; D016026:Bone Marrow Transplantation; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D007668:Kidney / Q000528:radiation effects*; D007938:Leukemia / Q000401:mortality / Q000532:radiotherapy* / Q000601:surgery; D015464:Leukemia, Myelogenous, Chronic, BCR-ABL Positive / Q000401:mortality / Q000532:radiotherapy / Q000601:surgery; D015470:Leukemia, Myeloid, Acute / Q000401:mortality / Q000532:radiotherapy / Q000601:surgery; D008297:Male; D008875:Middle Aged; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000401:mortality / Q000532:radiotherapy / Q000601:surgery; D012189:Retrospective Studies; D016019:Survival Analysis; D014916:Whole-Body Irradiation / Q000009:adverse effects