Bouillet Thierry, Ali Ali Mohammed, Thariat Juliette
Hôpital Avicenne, département de radiothérapie, Bobigny, France.
Bull Cancer. 2012 Mar 1;99(3):389-96. doi: 10.1684/bdc.2011.1479.
The kidneys are dose-limiting organs when total body irradiation or irradiation of the digestive tract is planned. The incidence of radiation-induced toxicity is probably underestimated due to its latency and confounding factors like chemotherapy.
A search of the literature for radiation induced renal toxicity was performed.
Most toxicities occur around 18 months. Renal mobility is significant in terms of dosimetric consequences, in particular in the young child. In case of total body irradiation, the dose responsible for a 5% risk of toxicities is around 16 Gy in 2 Gy fractions over 2 weeks. For partial renal irradiation, the volume receiving 20 Gy should be below 32% of the total renal volume. Compensatory mechanisms remain possible in areas receiving 12 Gy or less in 1 Gy fractions. When nephrotoxic chemotherapy, these tolerance doses must be lowered. Treatment of radiation-induced nephropathy may include ACE inhibitors.
DISCUSSION/CONCLUSION: Prospective assessment of dose-volume histograms and consideration of renal mobility in treatment plans along with improving radiation techniques should help to improve treatment plans including the kidneys.
当计划进行全身照射或消化道照射时，肾脏是剂量限制器官。由于辐射诱导毒性的潜伏期以及化疗等混杂因素，其发生率可能被低估。
对辐射诱导肾毒性的文献进行检索。
大多数毒性反应发生在18个月左右。肾脏移动性在剂量学后果方面具有重要意义，尤其是在幼儿中。在全身照射的情况下，在2周内分2 Gy分次给予导致5%毒性风险的剂量约为16 Gy。对于部分肾脏照射，接受20 Gy的体积应低于总肾体积的32%。在以1 Gy分次给予12 Gy或更低剂量的区域，代偿机制仍然可能存在。当使用肾毒性化疗时，这些耐受剂量必须降低。辐射诱导肾病的治疗可能包括使用血管紧张素转换酶抑制剂。
讨论/结论：前瞻性评估剂量体积直方图，并在治疗计划中考虑肾脏移动性，同时改进放射技术，应有助于改善包括肾脏在内的治疗计划。
