Association of Technetium(99m) MAG-3 renal scintigraphy with change in creatinine clearance following chemoradiation to the abdomen in patients with gastrointestinal malignancies.
BACKGROUND
Information on differential renal function following abdominal chemoradiation is limited. This study evaluated the association between renal function as measured by biochemical endpoints and scintigraphy and dose volume parameters in patients with gastrointestinal malignancies.


METHODS
Patients who received abdominal chemoradiation between 2002 and 2009 were identified for this study. Technetium(99m) MAG-3 scintigraphy and laboratory data were obtained prior to and after chemoradiation in 6 month intervals. Factors assessed included age, gender, hypertension, diabetes, and dose volume parameters. Renal function was assessed by biochemical endpoints and renal scintigraphy.


RESULTS
Significant reductions in relative renal function of the primarily irradiated kidney and creatinine clearance were seen. Split renal function decreased from 49.75% pre-radiation to 47.74% and 41.28% at 6-12 months and >12 months post-radiation (P=0.0184). Creatinine clearance declined from 90.67ml/min pre-radiation to 82.23ml/min and 74.54ml/min at 6-12 months and >12 months post-radiation (P<0.0001). Univariate analysis of patients who had at least one post-radiation renogram showed the percent volumes of the primarily irradiated kidney receiving ≥ 25 Gy (V(25)) and 40 Gy (V(40)) were significantly associated with ≥5% decrease in relative renal function (P=0.0387 and P=0.0438 respectively).


CONCLUSIONS
Decline in split renal function using Technetium(99m) MAG-3 scintigraphy correlates with decrease in creatinine clearance and radiation dose-volume parameters following abdominal chemoradiation. Change in split perfusion can be detected as early as 6 months post-radiation. Scintigraphy may provide early determination and quantification of subclinical renal injury prior to clinical evidence of nephropathy.
Department of Radiation Medicine, Roswell Park Cancer Institute, Buffalo, New York, USA.
Kilian Salerno
KS
May
Gary Y
GY
Yang
Nikhil I
NI
Khushalani
Rameela
R
Chandrasekhar
Gregory E
GE
Wilding
Leayn
L
Flaherty
Harish K
HK
Malhotra
Richard C
RC
Russo
John C
JC
Warner
Johnny C
JC
Yap
Renuka V
RV
Iyer
Chukwumere E
CE
Nwogu
Saikrishna S
SS
Yendamuri
John F
JF
Gibbs
Hector R
HR
Nava
Dominick
D
Lamonica
Charles R
CR
Thomas