立体定向体部放疗治疗胰腺癌后肾功能的量化：一项前瞻性临床试验的二次剂量分析
Quantification of renal function following stereotactic body radiotherapy for pancreatic cancer: secondary dosimetric analysis of a prospective clinical trial.
作者信息
Verma Vivek, Bhirud Abhijeet R, Denniston Kyle A, Bennion Nathan R, Lin Chi
机构信息
Department of Radiation Oncology, University of Nebraska Medical Center, 987521 Nebraska Medical Center, Ground Floor, Clarkson Tower, Omaha, NE, 68198, USA.
出版信息
Radiat Oncol. 2017 Apr 27;12(1):71. doi: 10.1186/s13014-017-0798-8.
BACKGROUND
This is the first known study examining renal function following stereotactic body radiotherapy (SBRT) for pancreatic head adenocarcinoma.
METHODS
Thirty-eight borderline-resectable/unresectable patients, part of an ongoing prospective trial, underwent 3 cycles of gemcitabine/5-fluorouracil followed by SBRT (5 daily fractions of 5/6/7/8 Gy) and concurrent nelfinavir. Thereafter, in resectable cases, surgery was performed within 4-8 weeks. The last available pre-SBRT creatinine was recorded, along with the highest post-SBRT value. Glomerular filtration rate (GFR) was calculated by the commonly-utilized Modification of Diet in Renal Disease formula. GFR decline was defined as the post-SBRT nadir GFR minus the pre-SBRT GFR. Correlations with the V5-V30, and mean/maximum kidney doses was performed. Statistics included Pearson correlation, Mann-Whitney, and Fisher's exact tests.
RESULTS
The median total kidney volume was 355 cm. Median dosimetric values were as follows: V5 (209 cm), V10 (103 cm), V15 (9 cm), V20 (0 cm), V25 (0 cm); and mean (6.7 Gy) & maximum kidney dose (18.3 Gy). Median GFR change was -23 (range, -105 to 25) mL/min/1.73 cm. Of all dosimetric parameters, only V5 was significantly associated with changes in GFR (Pearson r = -0.40, p = 0.012). In patients with V5 < 210 cm, median GFR change was -11.8 mL/min/1.73 cm, as compared with -37.1 mL/min/1.73 cm change in those with V5 ≥ 210 cm (p = 0.02). A GFR change < -23 mL/min/1.73 cm was observed in 6/20 (30%) patients with V5 < 210 cm, versus 15/18 (83%) of those with V5 ≥ 210 cm. Patients with V5 ≥ 210 cm were over ten times as likely to have GFR change < -23 mL/min/1.73 cm (p = 0.003). Using linear regression, GFR change ≈ -0.1748 × V5(cm) + 8.63.
CONCLUSIONS
In the first known analysis of renal function after pancreatic SBRT, evaluating patients on a prospective study, V5 ≥ 210 cm was associated with a post-SBRT GFR decline of >23 mL/min/1.73 cm. If V5 is kept <210 cm, median GFR decline was only 11.8 mL/min/1.73 cm. Further validation is needed to ascertain definite dose-volume parameters and examine late renal decline.
背景
这是第一项关于立体定向体部放疗（SBRT）治疗胰头腺癌后肾功能的已知研究。
方法
38例边界可切除/不可切除的患者，作为一项正在进行的前瞻性试验的一部分，接受3个周期的吉西他滨/5-氟尿嘧啶治疗，随后进行SBRT（5次每日分割，剂量为5/6/7/8 Gy）并同时使用奈非那韦。此后，在可切除的病例中，在4-8周内进行手术。记录SBRT前最后一次可用的肌酐值以及SBRT后最高值。肾小球滤过率（GFR）通过常用的肾脏疾病饮食改良公式计算。GFR下降定义为SBRT后最低点GFR减去SBRT前GFR。进行了与V5-V30以及平均/最大肾脏剂量的相关性分析。统计方法包括Pearson相关性分析、Mann-Whitney检验和Fisher精确检验。
结果
肾脏总体积中位数为355 cm。剂量学值中位数如下：V5（209 cm）、V10（103 cm）、V15（9 cm）、V20（0 cm）、V25（0 cm）；平均肾脏剂量（6.7 Gy）和最大肾脏剂量（18.3 Gy）。GFR变化中位数为-23（范围为-105至25）mL/min/1.73 cm²。在所有剂量学参数中，只有V5与GFR变化显著相关（Pearson r = -0.40，p = 0.012）。在V5＜210 cm的患者中，GFR变化中位数为-11.8 mL/min/1.73 cm²，而在V5≥210 cm的患者中为-37.1 mL/min/1.73 cm²（p = 0.02）。在V5＜210 cm的患者中，6/20（30%）观察到GFR变化＜-23 mL/min/1.73 cm²，而在V5≥210 cm的患者中为15/18（83%）。V5≥210 cm的患者GFR变化＜-23 mL/min/1.73 cm²的可能性是前者的十倍以上（p = 0.003）。使用线性回归分析，GFR变化≈ -0.1748×V5（cm²）+ 8.63。
结论
在第一项关于胰腺SBRT后肾功能的已知分析中，通过前瞻性研究评估患者，V5≥210 cm与SBRT后GFR下降＞23 mL/min/1.73 cm²相关。如果将V5保持在＜210 cm，GFR下降中位数仅为11.8 mL/min/1.73 cm²。需要进一步验证以确定明确的剂量-体积参数并检查晚期肾功能下降情况。
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