Analysis of Chronic Kidney Disease After Radiation Therapy for Gastric/Duodenal Mucosa-Associated Lymphoid Tissue Lymphoma

Abstract

Purpose This study aimed to evaluate the relationship between chronic kidney disease (CKD) after radiation therapy for gastric/duodenal mucosa-associated lymphoid tissue lymphoma and dose-volume histogram of the kidneys. Methods and Materials We retrospectively reviewed 40 patients who received 3-dimensional conformal radiation therapy. CKD was evaluated using the Common Terminology Criteria for Adverse Events version 5.0. The mean dose of bilateral kidneys/right kidney/left kidney (D mean of b-kidneys ) (D mean of r-kidney ) (D mean of l-kidney ), bilateral kidneys/right kidney/left kidney volume receiving ≥ x Gy (V x of b-kidneys ) (V x of r-kidney ) (V x of l-kidney ), and patients’ baseline clinical characteristics were analyzed. Results The median radiation therapy dose was 28 (range, 24-44.8) Gy in 14 fractions. The median follow-up period was 63.1 months, and the 5-year cumulative incidence of grade 2 CKD rate was 14.8%. Among several factors, V 5 of b-kidneys was most strongly associated with grade 2 or worse CKD, with an area under the curve of 0.81 in the receiver operating characteristic curve. The 5-year incidence rate in patients with V 5 of b-kidneys ≥ 58% was significantly higher than that in other patients (24.5% and 9.8%, respectively; P < .05). Conclusions In this study using 3-dimensional conformal radiation therapy, the rate of adverse events at 5 years was low, many patients showed toxicity after 5 years; thus, continuous follow-up is necessary to detect potential nephrotoxicity. Our data demonstrate that V 5 of b-kidneys was most strongly associated with the risk of CKD. With lower doses and more advanced techniques in recent years, the incidence of CKD may be further reduced.

Outcomes of Proton Therapy to Infradiaphragmatic Sites in Pediatric Patients with Hodgkin Lymphoma

“…]58% to the bilateral kidneys was strongly associated with CKD. [23] As a result, the COG Long-Term Follow-up Guidelines recommend close kidney surveillance if patients receive [? ]10 Gy.…”

Late Changes in Renal Volume and Function after Proton Beam Therapy in Pediatric and Adult Patients: Children Show Significant Renal Atrophy but Deterioration of Renal Function Is Minimal in the Long-Term in Both Groups

“…V5 in the irradiated kidneys has been suggested to have the strongest association with severe chronic renal failure of grade 2 or higher, based on a significantly higher 5-year incidence in patients with V5 ≥ 58%. This implies that V5 is particularly relevant to the risk of developing CKD [14]. In a post-SBRT study of pancreatic cancer, V5 of the irradiated kidney >210 cm 3 predicted a >23 mL/min/1.73 m 2 decrease in GFR after SBRT for pancreatic cancer, indicating that V5 is a predictor of significant nephrotoxicity after SBRT [31].…”

“…In PBT for abdominal tumors such as hepatocellular carcinoma (HCC) in adults, the kidneys are commonly exposed unilaterally or bilaterally in irradiation of the primary lesion [13]. Thus, radiation-associated kidney disease is a delayed consequence of abdominal radiotherapy and is frequently characterized by increased levels of serum creatinine, proteinuria, anemia, and hypertension [14]. Moreover, the total parenchymal volume of kidneys exposed to radiation consistently diminishes from pre-treatment to 36-94 months post-treatment, with size reduction of 23% (26 mm) and volume loss of 47% (91 mL) [15].…”

Motion Management: The Road Map to Accurate Radiation Treatment Delivery

“…The acceptable dose for organs at risk follows well-established guidelines and has been extensively studied [1][2][3][4][5][6]. A summary document considering all relevant published data has been introduced in the most recent version of the NCCN Guidelines 2023 [7].…”