Clinical Report: Renal Function Decline After Radiation Therapy
Overview
This study evaluates the impact of stereotactic ablative radiotherapy (SABR) on renal function in patients with primary renal cell carcinoma (pRCC). Findings indicate a significant decline in chronic kidney disease (CKD) progression related to renal dose, highlighting the need for careful dose management in SABR.
Background
Renal cell carcinoma (RCC) is a prevalent malignancy with surgical interventions often leading to renal function decline. Stereotactic ablative radiotherapy (SABR) has emerged as a potential treatment for patients who are medically inoperable, yet the long-term effects on renal function remain inadequately understood. Understanding the dose-response relationship is crucial for optimizing treatment while minimizing renal damage.
Data Highlights
Parameter
Value
Patients screened
731
Patients included
232
Median follow-up (days)
170
CKD deterioration rate
46.98%
Average kidney dose (EQD2)
14.2 Gy
Peak kidney dose (EQD2)
14.6 Gy
Independent predictor HR (mean dose)
1.04/Gy
Thresholds for CKD progression (mean dose)
18.7 Gy
Thresholds for CKD progression (max dose)
19.0 Gy
Key Findings
46.98% of patients experienced CKD deterioration post-treatment.
Median time to CKD deterioration was 173 days.
Increased renal dose was an independent predictor of renal function decline.
Female gender was identified as a significant risk factor for CKD progression.
Established dose thresholds for CKD progression were 18.7 Gy (mean) and 19.0 Gy (max).
Clinical Implications
The findings suggest that careful monitoring of renal doses during SABR is essential to mitigate the risk of CKD progression. Clinicians should consider gender differences when evaluating patient risk profiles for renal function decline.
Conclusion
SABR for pRCC is associated with a dose-dependent reduction in renal function, emphasizing the importance of optimizing treatment planning to protect renal tissue.
by Marthe Sophie Kilian, Laura Anna Fischer, Jona Bensberg, Lisa-Antonia von Diest, Carla Marie Zwerenz, Mahalia Z. Anczykowski, Stephanie Bendrich, Manuel Guhlich, Martin Leu, Leif Hendrik Dröge, Tibor I. Kesztyüs, Annemarie Uhlig, Stefan Rieken, Rami A. El Shafie
