Analysis of Chronic Renal Failure Following Radiotherapy for Gastric/Duodenal Mucosa-associated Lymphoid Tissue Lymphoma at a Single Institution

Abstract

multiregional primary site (OR 0.66 vs. HN) were less likely to receive RT alone. Among patients treated with CMT, the majority (64.6%) received 30 to 36 Gy, while 19.1% received >20 to <30 Gy, 7.3% received exactly 20 Gy, 4.6% received >36 Gy, and 4.4% received <20 Gy. The use of 20 Gy was more common at academic facilities (11% vs. 7-9% at other facilities) and increased significantly after 2010, with rates of 1-9% in 2004-2009 and 9-17% in 2010-2015. Adjusting for competing variables, use of 20 Gy (vs. 30 to 36 Gy) was less common for thorax site (OR 0.43 vs. HN), stage II disease (OR 0.41), B symptoms (OR 0.33), and Medicaid or uninsured patients (OR 0.70 and 0.52, respectively vs. private insurance). 20 Gy dosing was more common with increasing distance from treatment center (OR 2.9 for >100 miles) and later year of diagnosis (OR 6.3 for 2010-2015 vs 2004-2009). Use of dose >36 Gy decreased over time (4-9% in 2004-2009 vs 2-4% in 2010-2015). Conclusion: Of patients receiving RT for early stage HL, 12% receive RT alone. Adjusting for co-variates, RT alone (vs. CMT) is more common among patients with NLPHL, older age, black race, and axilla or groin disease, but less common in those with B symptoms, stage II disease, and thoracic disease. Of those treated with CMT, there is a wide variability in RT dose. The use of 20 Gy is increasing since 2010 and is more common in patients with stage I disease, no B symptoms, HN site, academic facility, and greater distance from facility.

Guideline for the diagnosis and management of marginal zone lymphomas: A British Society of Haematology Guideline

“…Treatment should be given with an empty stomach and planned with an advanced technique such as intensity modulation to minimise radiation dose to the heart, liver and kidneys. [95][96][97][98] While most studies have included patients treated with ≥30 Gy, a recent series shows that 24 Gy is likely to be adequate 97 and unlikely to cause significant acute toxicity. With appropriate RT planning, the dose delivered to critical structures can be kept well below organ tolerance, reducing the risk of long-term complications.…”

“…Involved‐site radiotherapy (ISRT) should include the entire stomach and, if involved, adjacent lymph nodes. Treatment should be given with an empty stomach and planned with an advanced technique such as intensity modulation to minimise radiation dose to the heart, liver and kidneys 95–98 …”