Department of Radiation Medicine, Roswell Park Cancer Institute, Buffalo, NY, USA.
Int J Radiat Oncol Biol Phys. 2010 Oct 1;78(2):539-46. doi: 10.1016/j.ijrobp.2009.07.1744. Epub 2010 Feb 3.
To identify factors predictive of renal atrophy after chemoradiotherapy of gastrointestinal malignancies.
Patients who received chemotherapy and abdominal radiotherapy (RT) between 2002 and 2008 were identified for this study evaluating change in kidney size and function after RT. Imaging and biochemical data were obtained before and after RT in 6-month intervals. Kidney size was defined by craniocaudal measurement on CT images. The primarily irradiated kidney (PK) was defined as the kidney that received the greater mean kidney dose. Receiver operating characteristic (ROC) curves were generated to predict risk for renal atrophy.
Of 130 patients, median age was 64 years, and 51.5% were male. Most primary disease sites were pancreas and periampullary tumors (77.7%). Median follow-up was 9.4 months. Creatinine clearance declined 20.89%, and size of the PK decreased 4.67% 1 year after completion of chemoradiation. Compensatory hypertrophy of the non-PK was not seen. Percentage volumes of the PK receiving ≥10 Gy (V(10)), 15 Gy (V(15)), and 20 Gy (V(20)) were significantly associated with renal atrophy 1 year after RT (p = 0.0030, 0.0029, and 0.0028, respectively). Areas under the ROC curves for V(10), V(15), and V(20) to predict >5% decrease in PK size were 0.760, 0.760, and 0.762, respectively.
Significant detriments in PK size and renal function were seen after abdominal RT. The V(10), V(15), and V(20) were predictive of risk for PK atrophy 1 year after RT. Analyses suggest the association of lower-dose renal irradiation with subsequent development of renal atrophy.
确定胃肠道恶性肿瘤化放疗后发生肾萎缩的预测因素。
本研究评估了化放疗后肾脏大小和功能的变化，对 2002 年至 2008 年间接受化疗和腹部放疗（RT）的患者进行了研究。在 RT 前后每 6 个月获得影像学和生化数据。肾脏大小通过 CT 图像的头尾测量来定义。主要照射的肾脏（PK）定义为接受更大平均肾脏剂量的肾脏。生成接收器操作特性（ROC）曲线来预测肾萎缩的风险。
在 130 名患者中，中位年龄为 64 岁，51.5%为男性。大多数原发疾病部位为胰腺和壶腹周围肿瘤（77.7%）。中位随访时间为 9.4 个月。肌酐清除率下降 20.89%，PK 大小在化放疗完成后 1 年下降 4.67%。未观察到非 PK 的代偿性肥大。PK 接受≥10Gy（V（10））、15Gy（V（15））和 20Gy（V（20））的百分比体积与 RT 后 1 年的肾萎缩显著相关（p=0.0030、0.0029 和 0.0028，分别）。ROC 曲线下面积分别为 V（10）、V（15）和 V（20）预测 PK 大小减少>5%的 0.760、0.760 和 0.762。
腹部 RT 后 PK 大小和肾功能明显下降。V（10）、V（15）和 V（20）可预测 RT 后 1 年 PK 萎缩的风险。分析表明，较低剂量的肾脏照射与随后发生的肾萎缩有关。
