Ureteral stent insertion for gynecologic interstitial high-dose-rate brachytherapy

Demanes, D. Jeffrey; Banerjee, Robyn; Cahan, Benjamin; Lee, Steve P.; Park, Sang-June; Fallon, Julia; Reyes, Paula; Van, Thanh; Steinberg, Michael L.; Kamrava, Mitchell

doi:10.1016/j.brachy.2014.11.013

Cited by 18 publications

(7 citation statements)

References 14 publications

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“…The priority depends on the judgment of the radiation oncologist. Hydronephrosis caused by radiation-induced ureter stenosis [15] may trigger renal dysfunction; we did not encounter this problem.…”

Section: Discussionmentioning

confidence: 92%

Dosimetric predictors of nephrotoxicity in patients receiving extended-field radiation therapy for gynecologic cancer

et al. 2021

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Purpose We sought dosimetric predictors of a decreasing estimated glomerular filtration rate (eGFR) in gynecological oncology patients receiving extended-field radiation therapy (EFRT). Materials and methods Between July 2012 and April 2020, 98 consecutive cervical or endometrial cancer patients underwent EFRT or whole-pelvis radiation therapy (WPRT) with concurrent cisplatin chemotherapy in our institution. To explore the effect of concurrent cisplatin chemotherapy on renal function, the renal function of the WPRT patients was examined. Of the 98 patients, 34 cervical or endometrial cancer patients underwent EFRT including extended-field intensity-modulated radiation therapy (EF-IMRT) and 64 cervical cancer patients underwent WPRT with cisplatin. Of the 34 EFRT patients, 32 underwent concurrent cisplatin chemotherapy. Excluding patients exhibiting recurrences within 6 months, 31 EFRT patients were analyzed in terms of the dose-volume kidney histograms (the percentages of kidney volumes receiving 12, 16, 20, and 24 Gy) and the post- to pre-treatment eGFR ratios. We calculated Pearson correlation coefficients between the renal dose volume and the percentage eGFR reductions of the 31 EFRT patients, and those treated via EF-IMRT. Renal dose constraint significance was evaluated using the Mann–Whitney U test. Results The eGFR value after WPRT with cisplatin remained largely unchanged for 12 months, unlike that after EFRT. In EFRT patients, a strong correlation was evident between the KV20Gy dose and the post- to pre-treatment eGFR ratio (correlation coefficients − 0.80 for all patients and − 0.74 for EF-IMRT patients). In EF-IMRT patients, the kidney volume receiving 20 Gy tended to correlate negatively with the eGFR reduction. The Mann–Whitney U test showed that patients with KV20Gy values < 10% retained significantly better renal function than did patients with KV20Gy values > 10% (P = 0.002). Conclusions Imposition of a severe kidney dose constraint during EF-IMRT may reduce nephrotic toxicity. Future prospective investigations of kidney-sparing EF-IMRT are required.

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Section: Discussionmentioning

confidence: 92%

Dosimetric predictors of nephrotoxicity in patients receiving extended-field radiation therapy for gynecologic cancer

et al. 2021

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“…Hence ureteric stenting before radiation treatment planning process has many potential benefits such as improvement of renal functional status, uninterrupted radiation therapy, better toleration of full dose cisplatin chemotherapy and safe intravenous contrast injection during computed tomography [CT] or magnetic resonance imaging [MRI]. Ureteric stenting also helps in identification, contouring and application of dose constraints to ureters during interstitial brachytherapy [4].…”

Section: Introductionmentioning

confidence: 99%

The Prognostic Significance of Hydronephrosis and Role of Ureteric Stenting in Cervical Cancer Patients Treated with Radical Radiation Therapy, Real World Outcomes from a Regional Cancer Centre, South India

Ganesarajah

Jayapaul²,

Madhavan³

et al. 2022

Asian Pac J Cancer Care

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Background: The incidence of renal failure in carcinoma cervix ranges from 14% to 44·2%. The interventional strategies like ureteric stenting and percutaneous nephrostomy can be considered to improve renal function. The primary objective of our study is to analyze the impact of hydroureteronephrosis [HUN] in the outcome of cervical cancer patients treated with radical radiation. The secondary objective is to analyze the role of ureteric stenting to protect the renal function while proceeding with radical radiation. Methods: In this retrospective study, all patients with stage IIIB cervical cancer treated with radical radiation therapy at our institution from January 2010 to December 2019 were included. Results: Among the total 483 stage IIIB patients, 146 patients [30·22%] had hydronephrosis.Thirty eight [26·02%] out of 146 patients with HUN underwent ureteric stenting. The five year overall survival [OS] was 61·4 ± 0·04 % and on subset analysis, overallsurvival was 65·7 ± 0·05 % for patients without HUN and 50·6 ± 0·06 % for patientswith HUN. [P value <0·001]. Among patients with hydronephrosis, those with bilateral hydronephrosis or serum creatinine >1·1 mg/dL have benefitted more from stenting. In this high risk subgroup, the one year overall survival was 65·2 ± 0·11 % and 42·4 ±0·13 % for patients with and without stenting. [p value 0·07]. No major stent related morbidity occurred. Conclusions: Hydronephrosis in cervical cancer patients indicates bad prognosis which results in decreased survival. The presence of hydronephrosis should be redesignated as a separate substage, IIIB2 in future FIGO updates, for better prognostication and treatment recommendations. The relief of obstructive uropathy should be sought out inpatients with serum creatinine levels > 1·1 mg/dL or bilateral hydronephrosis before theinitiation of oncological treatment.

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“…Ureteral stricture is defined as ureter narrowing causing functional obstruction. It often results from aging, stones, surgical injury, malignancy, radiotherapy, inflammation, fibrosis, infection, ischemia, and trauma [ 1 , 2 , 3 , 4 ]. In particular, the well-accepted flexible ureteroscopy for upper tract stone management has led to increased incidence of iatrogenic ureteral stricture [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

Biodegradable Stent with mTOR Inhibitor-Eluting Reduces Progression of Ureteral Stricture

Su²,

Chang

et al. 2021

IJMS

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In this study, we investigated the effect of mTOR inhibitor (mTORi) drug-eluting biodegradable stent (DE stent), a putative restenosis-inhibiting device for coronary artery, on thermal-injury-related ureteral stricture in rabbits. In vitro evaluation confirmed the dose-dependent effect of mTORi, i.e., rapamycin, on fibrotic markers in ureteral component cell lines. Upper ureteral fibrosis was induced by ureteral thermal injury in open surgery, which was followed by insertion of biodegradable stents, with or without rapamycin drug-eluting. Immunohistochemistry and Western blotting were performed 4 weeks after the operation to determine gross anatomy changes, collagen deposition, expression of epithelial–mesenchymal transition markers, including Smad, α-SMA, and SNAI 1. Ureteral thermal injury resulted in severe ipsilateral hydronephrosis. The levels of type III collagen, Smad, α-SMA, and SNAI 1 were increased 28 days after ureteral thermal injury. Treatment with mTORi-eluting biodegradable stents significantly attenuated thermal injury-induced urinary tract obstruction and reduced the level of fibrosis proteins, i.e., type III collagen. TGF-β and EMT signaling pathway markers, Smad and SNAI 1, were significantly modified in DE stent-treated thermal-injury-related ureteral stricture rabbits. These results suggested that intra-ureteral administration of rapamycin by DE stent provides modification of fibrosis signaling pathway, and inhibiting mTOR may result in fibrotic process change.

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Ureteral stent insertion for gynecologic interstitial high-dose-rate brachytherapy

Cited by 18 publications

References 14 publications

Dosimetric predictors of nephrotoxicity in patients receiving extended-field radiation therapy for gynecologic cancer

Dosimetric predictors of nephrotoxicity in patients receiving extended-field radiation therapy for gynecologic cancer

The Prognostic Significance of Hydronephrosis and Role of Ureteric Stenting in Cervical Cancer Patients Treated with Radical Radiation Therapy, Real World Outcomes from a Regional Cancer Centre, South India

Biodegradable Stent with mTOR Inhibitor-Eluting Reduces Progression of Ureteral Stricture

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