title: Pelvic radiotherapy in patients with hydronephrosis in stage IIIB cancer of the cervix: renal effects and the optimal timing for urinary diversion?
abstract: OBJECTIVE
  Many patients with Stage IIIB cervix cancer (Ca) and hydronephrosis will require ureteral stenting. The timing is important as delays or prolonged overall treatment times adversely affect outcome. Our aim was to measure the effect of pelvic radiotherapy (R/T) on renal function and identify a subset of patients at high risk of acute urinary obstruction during R/T.
  
  
  METHODS
  From 1/1/2000 to 1/1/2002, all patients with Stage IIIB cervix Ca and hydronephrosis were analysed retrospectively. To quantify the impact of pelvic R/T, all eligible patients from 1/7/2002-1/7/2004 had prospectively recorded baseline biochemistry, creatinine clearance and renal ultrasounds; these were repeated weekly to detect any change in renal function or degree of hydronephrosis.
  
  
  RESULTS
  13 eligible patients were analysed retrospectively, 5 with unilateral hydronephrosis with 40% requiring urinary diversion (UD). 8 had bilateral hydronephrosis, with 75% requiring UD; 50% before R/T and 35% during R/T. Average creatinine clearance (CrCl) was 74 mL/min (1.24 mL/s) in unilateral hydronephrosis , bilateral = 52 mL/min (0.87 mL/s), in those stented during R/T it was < 40 mL/min (0.67 mL/s). The resulting break in R/T was 6 and 19 days. In the prospective study, 5 patients were eligible and 4 consented. 75% had unilateral hydronephrosis and did not require UD with an average CrCl = 71 mL/min (1.19 mL/s). 1 patient with bilateral hydronephrosis had a CrCl of < 20 mL/min (0.33 mL/s) with bilateral stents placed before R/T.
  
  
  CONCLUSIONS
  Patients with bilateral hydronephrosis and a low CrCl < 50 mL/min (0.84 mL/s) should be considered for elective UD prior to R/T. Pelvic R/T did not induce any deterioration in renal function or degree of hydronephrosis.
authors.affiliation: Oncology Centre, Box 193, Addenbrooke's Hospital, Hills Road, Cambridge, CB2 2QQ, UK. ghoran@doctors.org.uk
authors.forename: G
authors.initials: G
authors.lastname: Horan
authors.forename: O
authors.initials: O
authors.lastname: McArdle
authors.forename: J
authors.initials: J
authors.lastname: Martin
authors.forename: C D
authors.initials: CD
authors.lastname: Collins
authors.forename: C
authors.initials: C
authors.lastname: Faul
mesh_terms: D058186:Acute Kidney Injury / Q000209:etiology*; D000230:Adenocarcinoma / Q000139:chemically induced / Q000473:pathology / Q000532:radiotherapy / Q000652:urine; D002294:Carcinoma, Squamous Cell / Q000150:complications / Q000473:pathology / Q000532:radiotherapy / Q000652:urine; D003404:Creatinine / Q000652:urine; D005260:Female; D006801:Humans; D006869:Hydronephrosis / Q000209:etiology / Q000601:surgery* / Q000652:urine; D009367:Neoplasm Staging; D011446:Prospective Studies; D011832:Radiation Injuries / Q000209:etiology* / Q000517:prevention & control; D012189:Retrospective Studies; D015607:Stents; D014547:Urinary Diversion / Q000379:methods*; D002583:Uterine Cervical Neoplasms / Q000150:complications* / Q000473:pathology / Q000532:radiotherapy* / Q000652:urine
chemical_list: D003404:Creatinine