title: The potential nephrotoxic effects of intensity modulated radiotherapy delivered to the para-aortic area of women with gynecologic malignancies: preliminary results.
abstract: OBJECTIVE
  To assess kidney function via creatinine clearance before and after radiotherapy in gynecologic cancer patients treated to the para-aortic (PA) area via Intensity Modulated Radiotherapy (IMRT).
  
  
  METHODS
  Twenty-three patients underwent IMRT to the para-aortic area, were followed for at least 5 months, and had the necessary laboratory data to calculate creatinine clearance. Various patient-related factors and radiotherapy-treatment related factors were analyzed to determine their association with changes in CrCl.
  
  
  RESULTS
  Median follow-up was 10.9 months (range, 5-19 months). Median patient age was 51.7 years (range, 22-78). The average initial CrCl was noted to be 109.23 mL/min (range, 38.64-188.38) before radiotherapy and decreased to 90.00 mL/min (29.31-175.61) after radiotherapy (P = 0.004). Although 17 patients had a decrease in their CrCl, 6 were found to have a slight elevation. Five factors were associated with a decrement in CrCl greater than the average decrease (17.6%): presence of hydronephrosis, age <50, no history of cisplatin treatment, a BED to gross adenopathy exceeding mean BED, and salvage treatment of PA node recurrence. Subgroup analysis revealed that the only statistically significant change within the group of patient and/or treatment-related factors was between patients who were <50-year-old and patients who were > or =50 years of age (P = 0.03). No patient exhibited clinical signs of radiation-induced nephropathy.
  
  
  CONCLUSIONS
  With a median follow-up of 10.9 months, the estimated CrCl decreased by 17.6% after IMRT to the para-aortic area +/- cisplatin chemotherapy. The greatest decrease in CrCl occurred in patients who had a history of hydronephrosis. Subgroup analysis revealed that the decline in CrCl was significantly greater for patients younger than 50 years of age. Interestingly, a greater decline in CrCl was noted for those patients who did not have a history of cisplatin treatment. Our preliminary results indicate that IMRT +/- cisplatin chemotherapy to the para-aortic area of women is safe and is not associated with any clinical sequelae of renal toxicity despite a small decrement in CrCl in most, but not all patients.
authors.affiliation: Department of Radiation Oncology, Beth Israel Deaconess Medical Center, USA.
authors.forename: John M
authors.initials: JM
authors.lastname: Varlotto
authors.forename: Kristina
authors.initials: K
authors.lastname: Gerszten
authors.forename: Dwight E
authors.initials: DE
authors.lastname: Heron
authors.forename: John
authors.initials: J
authors.lastname: Comerci
authors.forename: Shiva
authors.initials: S
authors.lastname: Gautam
authors.forename: Raj
authors.initials: R
authors.lastname: Selvaraj
authors.forename: Ron
authors.initials: R
authors.lastname: Lalonde
authors.forename: Justin C
authors.initials: JC
authors.lastname: Chura
mesh_terms: D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use; D001012:Aorta, Abdominal / Q000528:radiation effects; D002945:Cisplatin / Q000627:therapeutic use; D003404:Creatinine / Q000378:metabolism*; D019583:Dose Fractionation, Radiation; D005260:Female; D005833:Genital Neoplasms, Female / Q000188:drug therapy / Q000532:radiotherapy*; D006801:Humans; D007674:Kidney Diseases / Q000209:etiology; D008875:Middle Aged; D011832:Radiation Injuries / Q000503:physiopathology*
chemical_list: D000970:Antineoplastic Agents; D003404:Creatinine; D002945:Cisplatin