title: Postoperative chemoradiotherapy following pancreaticoduodenectomy. Impact of dose-volumetric parameters on the development of diabetes mellitus.
abstract: OBJECTIVE
  The purpose of this research was to analyze the relationship between dose-volumetric parameters and the development of diabetes mellitus (DM) in patients treated with chemoradiotherapy (CRT) following curative resection for upper gastrointestinal (GI) cancers.
  
  
  METHODS
  Medical records of patients who underwent postoperative CRT following curative resection, either pancreaticoduodenectomy (PD) or pylorus preserving pancreaticoduodenectomy (PPPD) for upper GI cancers including pancreas, biliary, ampullary, and duodenal cancers, between January 2006 and December 2008 were retrospectively reviewed. A total of 42 patients who were regularly followed for at least 2 years were included for analysis. Dose-volumetric parameters such as remnant pancreatic volume, mean dose, maximum dose (Dmax), and percentage of volume receiving specific dose or more were obtained from pre- and postoperative CT scan images and treatment plan.
  
  
  RESULTS
  Dmax and V50 (percentage of volume receiving at least 50 Gy) were statistically significant factors for the development of DM (p = 0.013, p = 0.031, respectively). The sensitivity and specificity of Dmax was 0.875 and 0.559, with cut-off value of 51.1 Gy, respectively. V50 had sensitivity of 0.875 and specificity of 0.618 for cut-off value of 16 %. No patient-related factor other than pretreatment cerebrovascular events was associated with the development of DM. On multivariate analysis, V50 was the only factor with statistical significance (p = 0.028), whereas Dmax showed borderline significance (p = 0.079).
  
  
  CONCLUSIONS
  V50 was the only independent factor associated with the development of diabetes and may function as guideline to predict the development of DM in patients receiving CRT following curative resection.
authors.affiliation: Department of Radiation Oncology, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, 110-744, Seoul, Korea.
authors.forename: K
authors.initials: K
authors.lastname: Eom
authors.forename: E K
authors.initials: EK
authors.lastname: Chie
authors.forename: K
authors.initials: K
authors.lastname: Kim
authors.forename: J J
authors.initials: JJ
authors.lastname: Jang
authors.forename: S W
authors.initials: SW
authors.lastname: Kim
authors.forename: D Y
authors.initials: DY
authors.lastname: Oh
authors.forename: S A
authors.initials: SA
authors.lastname: Im
authors.forename: T Y
authors.initials: TY
authors.lastname: Kim
authors.forename: Y J
authors.initials: YJ
authors.lastname: Bang
authors.forename: S W
authors.initials: SW
authors.lastname: Ha
mesh_terms: D000328:Adult; D015984:Causality; D059186:Chemoradiotherapy, Adjuvant / Q000401:mortality*; D015897:Comorbidity; D003920:Diabetes Mellitus / Q000401:mortality*; D005260:Female; D005770:Gastrointestinal Neoplasms / Q000401:mortality* / Q000628:therapy*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D016577:Pancreaticoduodenectomy / Q000401:mortality*; D011182:Postoperative Care / Q000401:mortality*; D011379:Prognosis; D011879:Radiotherapy Dosage; D056910:Republic of Korea / Q000453:epidemiology; D012189:Retrospective Studies; D018570:Risk Assessment; D016019:Survival Analysis; D015996:Survival Rate; D016896:Treatment Outcome; D047368:Tumor Burden
references.citation: Int J Radiat Oncol Biol Phys. 1999 Sep 1;45(2):323-9
references.pmid: 10487552
references.citation: Am J Surg. 1976 Nov;132(5):577-80
references.pmid: 984298
references.citation: Strahlenther Onkol. 2013 Mar;189(3):216-22
references.pmid: 23354440
references.citation: Diabetes Care. 1997 Jul;20(7):1183-97
references.pmid: 9203460
references.citation: Arch Intern Med. 2009 Aug 10;169(15):1381-8
references.pmid: 19667301
references.citation: Strahlenther Onkol. 2010 Mar;186(3):149-56
references.pmid: 20165822
references.citation: Ann Surg. 2000 Mar;231(3):293-300
references.pmid: 10714621
references.citation: World J Surg. 2001 Apr;25(4):452-60
references.pmid: 11344398
references.citation: Radiother Oncol. 1991 Oct;22(2):143-4
references.pmid: 1957005
references.citation: J Clin Endocrinol Metab. 2006 Nov;91(11):4401-7
references.pmid: 16954158
references.citation: Blood. 2007 Feb 15;109(4):1765-72
references.pmid: 17047152
references.citation: Int J Radiat Oncol Biol Phys. 1988 Jun;14(6):1197-204
references.pmid: 3384721
references.citation: J Gastrointest Surg. 2012 Jan;16(1):80-7; discussion 87-8
references.pmid: 22058043
references.citation: Int J Radiat Oncol Biol Phys. 2005 Jul 15;62(4):1055-69
references.pmid: 15990009
references.citation: Arch Intern Med. 2010 Sep 13;170(16):1506-7
references.pmid: 20837842
references.citation: Radiology. 2005 Apr;235(1):208-15
references.pmid: 15703313
references.citation: ANZ J Surg. 2012 Jun;82(6):447-51
references.pmid: 22571457
references.citation: Lancet. 2000 Sep 16;356(9234):993-7
references.pmid: 11041401
references.citation: HPB (Oxford). 2013 Mar;15(3):170-4
references.pmid: 23374356
references.citation: Int J Radiat Oncol Biol Phys. 2008 Oct 1;72(2):568-74
references.pmid: 18793959
references.citation: J Pediatr Hematol Oncol. 2004 Feb;26(2):81-90
references.pmid: 14767193
references.citation: Gastroenterology. 2000 Nov;119(5):1324-32
references.pmid: 11054391
references.citation: Med J Aust. 2003 May 5;178(9):427-32
references.pmid: 12720507
references.citation: Int J Radiat Oncol Biol Phys. 2007 Mar 1;67(3):660-9
references.pmid: 17141973
references.citation: Surgery. 2004 Sep;136(3):617-23
references.pmid: 15349110
references.citation: J Hepatobiliary Pancreat Surg. 1999;6(3):303-11
references.pmid: 10526067
references.citation: Strahlenther Onkol. 2013 Mar;189(3):223-9
references.pmid: 23319256