title: Radiation-induced injury of the exocrine pancreas after chemoradiotherapy for gastric cancer.
abstract: OBJECTIVE
  The pancreas is located almost entirely within the treatment area for radiotherapy of gastric cancer. The aim of this study was to analyze radiation-induced injury of the exocrine pancreas.
  
  
  METHODS
  The study included 127 gastric cancer patients, who underwent preoperative or postoperative chemoradiotherapy. A total dose of 45 Gy was given in 25 fractions. Concurrent chemotherapy was 5-fluorouracil-based. Lipase and α-amylase were assayed before, during and after treatment.
  
  
  RESULTS
  Lipase and α-amylase deficiencies were found in 48.2% and 19.7% of patients, respectively. In the univariant analysis, age and pretreatment α-amylase and lipase activities influenced on risk of injury of the exocrine pancreas (p<0.05). Younger patients (<65 years) had a lower risk of hypoamylasemia than older patients. The probability of insufficiency was lower than 0.2 for patients with pretreatment α-amylase and lipase activities above 50 U/L and 55 U/L, respectively. The multivariate analyses of the time to hypolipasemia showed that only pretreatment lipase activity was significant.
  
  
  CONCLUSIONS
  Gastric cancer patients have an increased risk of exocrine pancreatic insufficiency after chemoradiotherapy. Thus, the pancreas should be regarded as an OAR. Measuring lipase activity should be the standard for assessing radiation-induced pancreatic injury.
authors.affiliation: Department of Radiotherapy, Maria Skłodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch, Poland. Electronic address: jerzywydmanski@gmail.com.
authors.forename: Jerzy
authors.initials: J
authors.lastname: Wydmanski
authors.affiliation: Department of Radiotherapy, Maria Skłodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch, Poland. Electronic address: polanowskipawel@gmail.com.
authors.forename: Pawel
authors.initials: P
authors.lastname: Polanowski
authors.affiliation: Department of Epidemiology, Maria Skłodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch, Poland. Electronic address: atukiendorf@io.gliwice.pl.
authors.forename: Andrzej
authors.initials: A
authors.lastname: Tukiendorf
authors.affiliation: Department of Analytics and Clinical Biochemistry, Maria Skłodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch, Poland. Electronic address: bmaslyk@io.gliwice.pl.
authors.forename: Barbara
authors.initials: B
authors.lastname: Maslyk
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use; D059248:Chemoradiotherapy / Q000009:adverse effects; D010188:Exocrine Pancreatic Insufficiency / Q000139:chemically induced / Q000209:etiology*; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage / Q000009:adverse effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D046790:Pancreas, Exocrine / Q000187:drug effects / Q000528:radiation effects; D011832:Radiation Injuries / Q000139:chemically induced / Q000209:etiology*; D013274:Stomach Neoplasms / Q000188:drug therapy* / Q000532:radiotherapy*
chemical_list: D005472:Fluorouracil
keywords: Gastric cancer; Hypoamylasemia; Hypolipasemia; Pancreas; Radiation induced pancreas injury; Radiotherapy