Department of Oncology, Dr. Lutfi Kirdar Kartal Education and Research Hospital, Turkey.
Radiother Oncol. 2013 May;107(2):195-9. doi: 10.1016/j.radonc.2013.04.013. Epub 2013 May 3.
Adjuvant radiotherapy combined with 5-fluorouracil based chemotherapy has become the new standard after curative resection in high risk gastric cancer. Beside many complications due to surgery, the addition of chemotherapy and radiotherapy as adjuvant treatment may lead to both acute and late toxicities. Pancreatic tissue irradiation during this adjuvant treatment because of incidental and unavoidable inclusion of the organ within the radiation field may affect exocrine and endocrine functions of the organ.
Fifty-three patients with gastric adenocarcinoma were evaluated for adjuvant chemoradiotherapy after surgery. While 37 out of 53 patients were treated postoperatively due to either serosal or adjacent organ or lymph node involvement, 16 patients without these risk factors were followed up regularly without any additional treatment and they served as the control group. Fasting blood glucose (FBG), hemoglobin A1c (HBA1c), insulin and C-peptide levels were measured in the control and study groups after the surgery and 6 months and 1 year later.
At the baseline there was no difference in FBG, HbA1c, C-peptide and insulin levels between the control and the study groups. At the end of the study there was a statistically significant decline in insulin and C-peptide levels in the study group, (7.5 ± 6.0 vs 4.5 ± 4.4 IU/L, p: 0.002 and 2.3 ± 0.9 vs 1.56 ± 0.9 ng/ml, p: 0.001) respectively.
Adjuvant radiotherapy in gastric cancer leads to a decrease in beta cell function and insulin secretion capacity of the pancreas with possible diabetes risk. Radiation-induced pancreatic injury and late effects of radiation on normal pancreatic tissue are unknown, but pancreas is more sensitive to radiation than known. This organ should be studied extensively in order to determine the tolerance doses and it should be contoured during abdominal radiotherapy planning as an organ at risk.
在高危胃癌患者中，根治性切除术后联合氟尿嘧啶为基础的化疗的辅助放疗已成为新标准。除了手术引起的许多并发症外，化疗和放疗作为辅助治疗的添加可能会导致急性和迟发性毒性。由于器官在放射野内的偶然和不可避免的包含，胰腺组织在辅助治疗期间的照射可能会影响器官的外分泌和内分泌功能。
评估了 53 例胃腺癌患者术后接受辅助放化疗的情况。其中 37 例患者因浆膜或邻近器官或淋巴结受累而接受治疗，16 例无这些危险因素的患者定期随访而未接受任何额外治疗，作为对照组。术后、6 个月和 1 年后，分别在对照组和研究组测量空腹血糖（FBG）、糖化血红蛋白（HbA1c）、胰岛素和 C 肽水平。
基线时，对照组和研究组的 FBG、HbA1c、C 肽和胰岛素水平无差异。研究结束时，研究组胰岛素和 C 肽水平显著下降（7.5±6.0 vs 4.5±4.4 IU/L，p：0.002 和 2.3±0.9 vs 1.56±0.9 ng/ml，p：0.001）。
胃癌的辅助放疗会导致胰腺β细胞功能和胰岛素分泌能力下降，可能有糖尿病风险。胰腺的放射性损伤和对正常胰腺组织的晚期效应尚不清楚，但胰腺对辐射比已知的更敏感。为了确定耐受剂量，应该对该器官进行广泛研究，并在腹部放疗计划中勾画作为危险器官。
