Pelvic radiation therapy with volumetric modulated arc therapy and intensity-modulated radiotherapy after renal transplant: A report of 3 cases.
Rep Pract Oncol Radiother
; 25(4): 548-555, 2020.
Article
em En
| MEDLINE
| ID: mdl-32494227
AIM: Describe characteristics and outcomes of three patients treated with pelvic radiation therapy after kidney transplant. BACKGROUND: The incidence of pelvic cancers in kidney transplant (KT) recipients is rising. Currently it is the leading cause of death. Moreover, treatment is challenging because anatomical variants, comorbidities, and associated treatments, which raises the concern of using radiotherapy (RT). RT has been discouraged due to the increased risk of urethral/ureteral stricture and KT dysfunction. MATERIALS AND METHODS: We reviewed the electronic health records and digital planning system of patients treated with pelvic RT between December 2013 and December 2018 to identify patients with previous KT. CASES DESCRIPTION: We describe three successful cases of KT patients in which modern techniques allowed full standard RT for pelvic malignances (2 prostate and 1 vaginal cancer) with or without elective pelvic nodal RT, without allograft toxicity at short and long follow-up (up to 60 months). CONCLUSION: When needed, RT modern techniques remain a valid option with excellent oncologic results and acceptable toxicity. Physicians should give special considerations to accomplish all OAR dose constraints in the patient's specific setting. Recent publications recommend KT mean dose <4â¯Gy, but graft proximity to CTV makes this unfeasible. We present 2 cases where dose constraint was not achieved, and to a short follow-up of 20 months renal toxicity has not been documented. We recommend the lowest possible mean dose to the KT, but never compromising the CTV coverage, since morbimortality from recurrent or progressive cancer disease outweighs the risk of graft injury.
BF, Biochemical failure; BT, Brachytherapy; C3D-RT, Conformal three-dimensional radiation therapy; CBCT, Cone-beam computed tomography; CCa, Cervix cancer; Dmax, Maximum dose; Dmean, Mean dose; Dmin, Minimum dose; Dx, Dose (in Gy) receiving x% of a volume or more; EBRT, External beam radiation therapy; EQD2, Equivalent dose in 2-Gy fractions; ESKD, End-stage kidney disease; FU, Follow-up; HPV, Human papillomavirus; IBT, Intracavitary brachytherapy; IMRT, Intensity-modulated radiation therapy; KT, Kidney transplant; Kidney allograft; LRDRT, Living related donor renal transplantation; MMF, Mycophenolate mofetil; NED, No evidence of disease; OAR, Organs at risk; OS, Overall survival; PCa, Prostate cancer; PDN, Prednisone; PP, Post-prostatectomy; PSA, Prostate-specific antigen; PTV, Planning target volume; Pelvic radiotherapy; Prostate cancer; RR, Risk ratio; RT, Radiation therapy; Renal transplant; SCCVa, Squamous cell carcinoma of the vagina; SIR, Standardized Incidence Ratio; TBI, Total body irradiation; VCa, Vaginal cancer; VMAT, Volumetric Modulated Arc Therapy; Vaginal cancer; Vx, Volume (in percentage) receiving x dose or more (in Gy); fr, Fractions; mo, Months
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1
Coleções:
01-internacional
Base de dados:
MEDLINE
Tipo de estudo:
Prognostic_studies
Idioma:
En
Revista:
Rep Pract Oncol Radiother
Ano de publicação:
2020
Tipo de documento:
Article
País de afiliação:
México
País de publicação:
Polônia