title: Delayed renal dysfunction after total body irradiation in pediatric malignancies.
abstract: The purpose of this study was to retrospectively evaluate the incidence of delayed renal dysfunction after total body irradiation (TBI) in long-term survivors of TBI/hematopoietic stem cell transplantation (HSCT). Between 1989 and 2006, 24 pediatric patients underwent TBI as part of the conditioning regimen for HSCT at Chiba University Hospital. Nine patients who survived for more than 5 years were enrolled in this study. No patient had any evidence of renal dysfunction prior to the transplant according to their baseline creatinine levels. The median age at the time of diagnosis was 6 years old (range: 1-17 years old). The follow-up period ranged from 79-170 months (median: 140 months). Renal dysfunction was assessed using the estimated glomerular filtration rate (eGFR). The TBI dose ranged from 8-12 Gy delivered in 3-6 fractions over 2-3 d. The patients were treated with linear accelerators in the supine position, and the radiation was delivered to isocentric right-left and left-right fields via the extended distance technique. The kidneys and the liver were not shielded except in one patient with a left adrenal neuroblastoma. No patient required hemodialysis. The eGFR of four patients (44.4%) progressively decreased. The remaining patients did not demonstrate any eGFR deterioration. Only one patient developed hypertension. By evaluating the changes in eGFR, renal dysfunction among long-term survivors of TBI/HSCT could be detected. Our results suggested that the TBI schedule of 12 Gy in 6 fractions over three consecutive days affects renal function.
authors.affiliation: Diagnostic Radiology and Radiation Oncology, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8677, Japan Department of Radiology, Chiba University Hospital, Chiba, Japan mwatanabe@hospital.chiba-u.jp.
authors.forename: Miho
authors.initials: M
authors.lastname: Watanabe Nemoto
authors.affiliation: Department of Radiology, Sakura Medical Center, Toho University, Chiba, Japan.
authors.forename: Koichi
authors.initials: K
authors.lastname: Isobe
authors.affiliation: Department of Radiology, Chiba University Hospital, Chiba, Japan.
authors.forename: Gentaro
authors.initials: G
authors.lastname: Togasaki
authors.affiliation: Department of Radiology, Chiba University Hospital, Chiba, Japan.
authors.forename: Aki
authors.initials: A
authors.lastname: Kanazawa
authors.affiliation: Department of Radiology, Chiba University Hospital, Chiba, Japan.
authors.forename: Marie
authors.initials: M
authors.lastname: Kurokawa
authors.affiliation: Department of Radiology, Chiba University Hospital, Chiba, Japan.
authors.forename: Makoto
authors.initials: M
authors.lastname: Saito
authors.affiliation: Department of Radiology, Chiba University Hospital, Chiba, Japan.
authors.forename: Rintaro
authors.initials: R
authors.lastname: Harada
authors.affiliation: Department of Radiology, Chiba University Hospital, Chiba, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Kobayashi
authors.affiliation: Diagnostic Radiology and Radiation Oncology, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8677, Japan.
authors.forename: Hisao
authors.initials: H
authors.lastname: Ito
authors.affiliation: Diagnostic Radiology and Radiation Oncology, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8677, Japan Department of Radiology, Chiba University Hospital, Chiba, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Uno
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006801:Humans; D007223:Infant; D007674:Kidney Diseases / Q000175:diagnosis* / Q000209:etiology*; D008137:Longitudinal Studies; D008297:Male; D009369:Neoplasms / Q000150:complications* / Q000532:radiotherapy*; D012189:Retrospective Studies; D018570:Risk Assessment; D017741:Survivors; D013997:Time Factors; D014916:Whole-Body Irradiation / Q000009:adverse effects*
keywords: long-term survivor; pediatrics; renal toxicity; total body irradiation