Renal function outcomes of high-risk neuroblastoma patients undergoing radiation therapy Journal Article

Authors: Beckham, T. H.; Casey, D. L.; LaQuaglia, M. P.; Kushner, B. H.; Modak, S.; Wolden, S. L.
Article Title: Renal function outcomes of high-risk neuroblastoma patients undergoing radiation therapy
Abstract: Purpose To analyze the renal function outcomes in patients undergoing radiation therapy for neuroblastoma. Methods and Materials The clinical metrics of renal function were analyzed in patients undergoing radiation therapy for high-risk neuroblastoma from 2000 to 2015. The blood urea nitrogen (BUN) and creatinine values before radiation therapy were compared with last available follow-up values and analyzed with the clinical circumstances, including follow-up length, age at primary irradiation, nephrectomy, and radiation technique. The creatinine clearance was estimated using the Shull method. Results With a median follow-up period of 3.5 years, none of the 266 patients studied developed a chronic renal insufficiency. For all patients, the creatinine level increased from 0.44 to 0.51 mg/dL and the BUN increased from 10.53 to 15.52 mg/dL. Three patients required antihypertensive medication. The patients who underwent intensity modulated radiation therapy did not experience increased creatinine levels during the follow-up period; however, they had a reduced median follow-up length compared with patients treated with anteroposterior/posteroanterior beams (4.7 vs 3.3 years). A longer follow-up length was associated with an increased creatinine level. The preradiation therapy creatinine level increased with patient age, similar to that of the last follow-up creatinine level, suggesting that the changes in creatinine could likely be explained by physiologic increases associated with aging rather than radiation-induced renal damage. The creatinine clearance did not decrease in any circumstance. Conclusions The present cohort had excellent renal outcomes after radiation therapy for neuroblastoma. No patient developed chronic renal insufficiency, and the small increases in BUN and creatinine we observed correlated, as expected, with increases in patient age. The results of the present study revealed a possible advantage for intensity modulated radiation therapy in preserving renal function; however, the follow-up length is a recognized confounding variable. The kidneys are vital structures to consider when planning radiation therapy for neuroblastoma patients, and we have found encouraging evidence that modern techniques to spare them in the setting of multiple treatment-related insults have been successful. © 2017 Elsevier Inc.
Keywords: intensity modulated radiation therapy; radiation; radiotherapy; patient monitoring; patient treatment; high-risk neuroblastoma; urea; radiation-induced; anteroposterior; methods and materials; blood urea nitrogens; modern techniques; renal functions
Journal Title: International Journal of Radiation Oncology, Biology, Physics
Volume: 99
Issue: 2
ISSN: 0360-3016
Publisher: Elsevier Inc.  
Date Published: 2017-10-01
Start Page: 486
End Page: 493
Language: English
DOI: 10.1016/j.ijrobp.2017.04.003
PROVIDER: scopus
PUBMED: 28872000
PMCID: PMC5674789
Notes: Article -- Export Date: 2 October 2017 -- Source: Scopus
Citation Impact
MSK Authors
  1. Brian Kushner
    272 Kushner
  2. Shakeel Modak
    213 Modak
  3. Suzanne L Wolden
    502 Wolden
  4. Dana   Casey
    51 Casey
  5. Thomas Hendrix Beckham
    17 Beckham