Universität zu Köln

Haneder, Stefan, Budjan, Johannes Michael, Schoenberg, Stefan Oswald, Konstandin, Simon, Schad, Lothar Rudi, Hofheinz, Ralf Dieter, Gramlich, Veronika, Wenz, Frederik, Lohr, Frank ORCID: 0000-0003-1014-5556 and Boda-Heggemann, Judit (2015). Dose-dependent changes in renal H-1-/Na-23 MRI after adjuvant radiochemotherapy for gastric cancer. Strahlenther. Onkol., 191 (4). S. 356 - 365. HEIDELBERG: SPRINGER HEIDELBERG. ISSN 1439-099X

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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.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Haneder, Stefan UNSPECIFIED UNSPECIFIED UNSPECIFIED Budjan, Johannes Michael UNSPECIFIED UNSPECIFIED UNSPECIFIED Schoenberg, Stefan Oswald UNSPECIFIED UNSPECIFIED UNSPECIFIED Konstandin, Simon UNSPECIFIED UNSPECIFIED UNSPECIFIED Schad, Lothar Rudi UNSPECIFIED UNSPECIFIED UNSPECIFIED Hofheinz, Ralf Dieter UNSPECIFIED UNSPECIFIED UNSPECIFIED Gramlich, Veronika UNSPECIFIED UNSPECIFIED UNSPECIFIED Wenz, Frederik UNSPECIFIED UNSPECIFIED UNSPECIFIED Lohr, Frank UNSPECIFIED orcid.org/0000-0003-1014-5556 UNSPECIFIED Boda-Heggemann, Judit UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-403185
DOI:	10.1007/s00066-014-0787-x
Journal or Publication Title:	Strahlenther. Onkol.
Volume:	191
Number:	4
Page Range:	S. 356 - 365
Date:	2015
Publisher:	SPRINGER HEIDELBERG
Place of Publication:	HEIDELBERG
ISSN:	1439-099X
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language CAPECITABINE-BASED CHEMORADIOTHERAPY; PHASE-III TRIAL; RADIOTHERAPY; CHEMOTHERAPY; CISPLATIN; TOXICITY; THERAPY; KIDNEYS; SURGERY Multiple languages Oncology; Radiology, Nuclear Medicine & Medical Imaging Multiple languages
URI:	http://kups.ub.uni-koeln.de/id/eprint/40318