Purpose Combined radiochemotherapy (RCT) for gastric cancer with three-dimensional conformal radiotherapy (3D-CRT) results in ablative doses to the upper left kidney, while image-guided intensity-modulated radiotherapy (IG-IMRT) allows kidney sparing despite improved target coverage. Renal function in long-term gastric cancer survivors was evaluated with 3T functional magnetic resonance imaging (MRI) including diffusion-weighted imaging (DWI) and Na-23 imaging. Patients and methods Five healthy volunteers and 13 patients after radiotherapy were included: 11xIG-IMRT; 1x3D-CRT; 1x "positive control" with stereotactic body radiotherapy (SBRT) of a metastasis between the spleen/left kidney. Radiation doses were documented for the upper/middle/lower kidney subvolumes. Late toxicity was evaluated based on CTC criteria, questionnaire, and creatinine values. Morphological sequences, DWI images, and Na-23 images were acquired using a H-1/Na-23-tuned body-coil before/after intravenous water load (WL). Statistics for [Na-23] (concentration) and apparent diffusion coefficient (ADC) values were calculated for upper/middle/lower renal subvolumes. Corticomedullary [Na-23] gradients and [Na-23] differences after WL were determined. Results No major morphological alteration was detected in any patient. Minor scars were observed in the cranial subvolume of the left kidney of the 3D-CRT and the whole kidney of the control SBRT patient. All participants presented a corticomedullary [Na-23] gradient. After WL, a significant physiological [Na-23] gradient decrease (p < 0.001) was observed in all HV and IG-IMRT patients. In the cranial left kidney of the 3D-CRT patient and the positive control SBRT patient, the decrease was nonsignificant (p = 0.01, p = 0.02). ADC values were altered nonsignificantly in all renal subvolumes (all participants). Renal subvolumes with doses a parts per thousand yenaEuro parts per thousand 35 Gy showed a reduced change of the [Na-23] gradient after WL (p = 0.043). No participants showed clinical renal impairment. Conclusions Functional parameters of renal Na-23 MRI after gastric IG-IMRT are identical to those of healthy volunteers, in contrast to renal subvolumes after ablative doses in the control and 3D-CRT patient. While kidney doses to the cortex below 20-25 Gy in fractional doses of similar to 1 Gy in IG-IMRT (combined with intensified chemotherapy) do not seem to cause significant MRI morphological or functional alterations, doses of > 35 Gy in 1.5-2 Gy fractions clearly result in impairment.

Dose-dependent changes in renal H-1-/Na-23 MRI after adjuvant radiochemotherapy for gastric cancer / Haneder, S; Budjan, Jm; Schoenberg, So; Konstandin, S; Schad, Lr; Hofheinz, Rd; Gramlich, V; Wenz, F; Lohr, F; Boda-Heggemann, J. - In: STRAHLENTHERAPIE UND ONKOLOGIE. - ISSN 0179-7158. - 191:4(2015), pp. 356-364. [10.1007/s00066-014-0787-x]

Dose-dependent changes in renal H-1-/Na-23 MRI after adjuvant radiochemotherapy for gastric cancer

Lohr F;
2015

Abstract

Purpose Combined radiochemotherapy (RCT) for gastric cancer with three-dimensional conformal radiotherapy (3D-CRT) results in ablative doses to the upper left kidney, while image-guided intensity-modulated radiotherapy (IG-IMRT) allows kidney sparing despite improved target coverage. Renal function in long-term gastric cancer survivors was evaluated with 3T functional magnetic resonance imaging (MRI) including diffusion-weighted imaging (DWI) and Na-23 imaging. Patients and methods Five healthy volunteers and 13 patients after radiotherapy were included: 11xIG-IMRT; 1x3D-CRT; 1x "positive control" with stereotactic body radiotherapy (SBRT) of a metastasis between the spleen/left kidney. Radiation doses were documented for the upper/middle/lower kidney subvolumes. Late toxicity was evaluated based on CTC criteria, questionnaire, and creatinine values. Morphological sequences, DWI images, and Na-23 images were acquired using a H-1/Na-23-tuned body-coil before/after intravenous water load (WL). Statistics for [Na-23] (concentration) and apparent diffusion coefficient (ADC) values were calculated for upper/middle/lower renal subvolumes. Corticomedullary [Na-23] gradients and [Na-23] differences after WL were determined. Results No major morphological alteration was detected in any patient. Minor scars were observed in the cranial subvolume of the left kidney of the 3D-CRT and the whole kidney of the control SBRT patient. All participants presented a corticomedullary [Na-23] gradient. After WL, a significant physiological [Na-23] gradient decrease (p < 0.001) was observed in all HV and IG-IMRT patients. In the cranial left kidney of the 3D-CRT patient and the positive control SBRT patient, the decrease was nonsignificant (p = 0.01, p = 0.02). ADC values were altered nonsignificantly in all renal subvolumes (all participants). Renal subvolumes with doses a parts per thousand yenaEuro parts per thousand 35 Gy showed a reduced change of the [Na-23] gradient after WL (p = 0.043). No participants showed clinical renal impairment. Conclusions Functional parameters of renal Na-23 MRI after gastric IG-IMRT are identical to those of healthy volunteers, in contrast to renal subvolumes after ablative doses in the control and 3D-CRT patient. While kidney doses to the cortex below 20-25 Gy in fractional doses of similar to 1 Gy in IG-IMRT (combined with intensified chemotherapy) do not seem to cause significant MRI morphological or functional alterations, doses of > 35 Gy in 1.5-2 Gy fractions clearly result in impairment.
2-dic-2014
191
4
356
364
Dose-dependent changes in renal H-1-/Na-23 MRI after adjuvant radiochemotherapy for gastric cancer / Haneder, S; Budjan, Jm; Schoenberg, So; Konstandin, S; Schad, Lr; Hofheinz, Rd; Gramlich, V; Wenz, F; Lohr, F; Boda-Heggemann, J. - In: STRAHLENTHERAPIE UND ONKOLOGIE. - ISSN 0179-7158. - 191:4(2015), pp. 356-364. [10.1007/s00066-014-0787-x]
Haneder, S; Budjan, Jm; Schoenberg, So; Konstandin, S; Schad, Lr; Hofheinz, Rd; Gramlich, V; Wenz, F; Lohr, F; Boda-Heggemann, J
File in questo prodotto:
Non ci sono file associati a questo prodotto.
Pubblicazioni consigliate

Caricamento pubblicazioni consigliate

Licenza Creative Commons
I metadati presenti in IRIS UNIMORE sono rilasciati con licenza Creative Commons CC0 1.0 Universal, mentre i file delle pubblicazioni sono rilasciati con licenza Attribuzione 4.0 Internazionale (CC BY 4.0), salvo diversa indicazione.
In caso di violazione di copyright, contattare Supporto Iris

Utilizza questo identificativo per citare o creare un link a questo documento: http://hdl.handle.net/11380/1172376
Citazioni
  • ???jsp.display-item.citation.pmc??? 1
  • Scopus 1
  • ???jsp.display-item.citation.isi??? 1
social impact