Prospective study on late renal toxicity following postoperative chemoradiotherapy in gastric cancer.
OBJECTIVE
Postoperative chemoradiotherapy in gastric cancer improves locoregional control and survival. Reports on late toxicity, however, have been scarce thus far. Because renal toxicity is one of the most serious late complications in upper abdominal radiotherapy, we prospectively analyzed kidney function in patients who underwent postoperative chemoradiotherapy for gastric cancer.


METHODS
In 44 patients, Tc99m-thiatide renography was performed before and at regular intervals after postoperative chemoradiotherapy. The left-to-right (L/R) ratio was used as an index of the relative kidney function. Mean L/R values were calculated for four follow-up time intervals. For all patients, kidney V20 (percentage of the volume of the kidney that received more than 20 Gy) and mean dose of both kidneys were retrieved from the three-dimensional dose-volume histograms.


RESULTS
We observed a progressive decrease in left renal function of 11% (p = 0.012) after 6 months, up to 52% (p < 0.001) after >18 months. The V20 (left kidney) and mean left kidney dose were identified as parameters associated with decreased kidney function. Mean serum creatinine was increased from 74.6 micromol/L before treatment to 86.1 micromol/L at 1 year after chemoradiotherapy (p < 0.001). In patients with a follow-up of 18-28 months, one case of severe renovascular hypertension was observed.


CONCLUSIONS
A progressive relative functional impairment of the left kidney in patients after postoperative chemoradiotherapy for gastric cancer is demonstrated. To optimize the survival benefit that can be established with adjuvant regimens, strategies to minimize the dose to the kidneys and other critical organs should be explored.
Jansen
Edwin P M
EP
Department of Radiotherapy, The Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands. epm.jansen@nki.nl
Saunders
Mark P
MP
Boot
Henk
H
Oppedijk
Vera
V
Dubbelman
Ria
R
Porritt
Bridget
B
Cats
Annemieke
A
Stroom
Joep
J
Valdés Olmos
Renato
R
Bartelink
Harry
H
Verheij
Marcel
M
D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000009:adverse effects; D015415:Biomarkers / Q000097:blood; D017024:Chemotherapy, Adjuvant / Q000009:adverse effects; D002945:Cisplatin / Q000009:adverse effects; D003404:Creatinine / Q000097:blood; D005260:Female; D006801:Humans; D007668:Kidney / Q000000981:diagnostic imaging / Q000187:drug effects / Q000528:radiation effects*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011832:Radiation Injuries / Q000000981:diagnostic imaging / Q000503:physiopathology*; D011877:Radionuclide Imaging; D011879:Radiotherapy Dosage; D018714:Radiotherapy, Adjuvant / Q000009:adverse effects; D013274:Stomach Neoplasms / Q000188:drug therapy* / Q000532:radiotherapy* / Q000601:surgery
D000970:Antineoplastic Agents; D015415:Biomarkers; D003404:Creatinine; D002945:Cisplatin