Katsuta Tsuyoshi, Matsuura Kanji, Kashiwado Kozo
Department of Radiation Oncology, Hiroshima Red Cross Hospital & Atomic-bomb Survivors Hospital, Sendamachi, Naka-ku, Hiroshima City, Hiroshima, Japan.
Department of Radiation Oncology, Hiroshima City Hospital Organization, Hiroshima City Hiroshima Citizens Hospital, Motomachi, Naka-ku, Hiroshima City, Hiroshima, Japan.
Adv Radiat Oncol. 2021 Sep 11;6(6):100788. doi: 10.1016/j.adro.2021.100788. eCollection 2021 Nov-Dec.
This study aimed to evaluate the relationship between chronic kidney disease (CKD) after radiation therapy for gastric/duodenal mucosa-associated lymphoid tissue lymphoma and dose-volume histogram of the kidneys.
We retrospectively reviewed 40 patients who received 3-dimensional conformal radiation therapy. CKD was evaluated using the Common Terminology Criteria for Adverse Events version 5.0. The mean dose of bilateral kidneys/right kidney/left kidney (D) (D) (D), bilateral kidneys/right kidney/left kidney volume receiving ≥ x Gy (V) (V) (V), and patients' baseline clinical characteristics were analyzed.
The median radiation therapy dose was 28 (range, 24-44.8) Gy in 14 fractions. The median follow-up period was 63.1 months, and the 5-year cumulative incidence of grade 2 CKD rate was 14.8%. Among several factors, V was most strongly associated with grade 2 or worse CKD, with an area under the curve of 0.81 in the receiver operating characteristic curve. The 5-year incidence rate in patients with V ≥ 58% was significantly higher than that in other patients (24.5% and 9.8%, respectively; < .05).
In this study using 3-dimensional conformal radiation therapy, the rate of adverse events at 5 years was low, many patients showed toxicity after 5 years; thus, continuous follow-up is necessary to detect potential nephrotoxicity. Our data demonstrate that V was most strongly associated with the risk of CKD. With lower doses and more advanced techniques in recent years, the incidence of CKD may be further reduced.
本研究旨在评估胃/十二指肠黏膜相关淋巴组织淋巴瘤放射治疗后慢性肾脏病（CKD）与肾脏剂量体积直方图之间的关系。
我们回顾性分析了40例接受三维适形放射治疗的患者。使用不良事件通用术语标准第5.0版评估CKD。分析双侧肾脏/右肾/左肾的平均剂量（D）（D）（D）、接受≥x Gy的双侧肾脏/右肾/左肾体积（V）（V）（V）以及患者的基线临床特征。
中位放射治疗剂量为28（范围24 - 44.8）Gy，分14次给予。中位随访期为63.1个月，2级CKD的5年累积发生率为14.8%。在多个因素中，V与2级或更严重CKD的相关性最强，在受试者工作特征曲线下面积为0.81。V≥58%的患者5年发生率显著高于其他患者（分别为24.5%和9.8%；P<0.05）。
在本项使用三维适形放射治疗的研究中，5年不良事件发生率较低，但许多患者在5年后出现毒性反应；因此，需要持续随访以检测潜在的肾毒性。我们的数据表明V与CKD风险的相关性最强。近年来随着剂量降低和技术进步，CKD的发生率可能会进一步降低。
