nach oben

Erschienen in:

01.09.2013 | Original article

Postoperative chemoradiotherapy following pancreaticoduodenectomy

Impact of dose–volumetric parameters on the development of diabetes mellitus

verfasst von: K. Eom, M.D., E.K. Chie, M.D., K. Kim, M.D., J.J. Jang, M.D, S.W. Kim, M.D., D.Y. Oh, M.D., S.A. Im, M.D., T.Y. Kim, M.D., Y.J. Bang, M.D., S.W. Ha, M.D.

Erschienen in: Strahlentherapie und Onkologie | Ausgabe 9/2013

Einloggen, um Zugang zu erhalten

Abstract

Purpose

The purpose of this research was to analyze the relationship between dose–volumetric parameters and the development of diabetes mellitus (DM) in patients treated with chemoradiotherapy (CRT) following curative resection for upper gastrointestinal (GI) cancers.

Patients and methods

Medical records of patients who underwent postoperative CRT following curative resection, either pancreaticoduodenectomy (PD) or pylorus preserving pancreaticoduodenectomy (PPPD) for upper GI cancers including pancreas, biliary, ampullary, and duodenal cancers, between January 2006 and December 2008 were retrospectively reviewed. A total of 42 patients who were regularly followed for at least 2 years were included for analysis. Dose–volumetric parameters such as remnant pancreatic volume, mean dose, maximum dose (D_max), and percentage of volume receiving specific dose or more were obtained from pre- and postoperative CT scan images and treatment plan.

Results

D_max and V₅₀ (percentage of volume receiving at least 50 Gy) were statistically significant factors for the development of DM (p = 0.013, p = 0.031, respectively). The sensitivity and specificity of D_max was 0.875 and 0.559, with cut-off value of 51.1 Gy, respectively. V₅₀ had sensitivity of 0.875 and specificity of 0.618 for cut-off value of 16 %. No patient-related factor other than pretreatment cerebrovascular events was associated with the development of DM. On multivariate analysis, V₅₀ was the only factor with statistical significance (p = 0.028), whereas D_max showed borderline significance (p = 0.079).

Conclusion

V₅₀ was the only independent factor associated with the development of diabetes and may function as guideline to predict the development of DM in patients receiving CRT following curative resection.

Yamaguchi K, Tanaka M, Chijiiwa K et al (1999) Early and late complications of pylorus-preserving pancreatoduodenectomy in Japan 1998. J Hepatobiliary Pancreat Surg 6:303–311PubMedCrossRef

Jimenez RE, Fernandez-del Castillo C, Rattner DW et al (2000) Outcome of pancreaticoduodenectomy with pylorus preservation or with antrectomy in the treatment of chronic pancreatitis. Ann Surg 231:293PubMedCrossRef

Rufat P (2000) Risk factors for diabetes mellitus in chronic pancreatitis. Gastroenterology 119:1324–1332PubMedCrossRef

Graham MV, Purdy JA, Emami B et al (1999) Clinical dose–volume histogram analysis for pneumonitis after 3D treatment for non-small cell lung cancer (NSCLC). Int J Radiat Oncol Biol Phys 45:323–329PubMedCrossRef

Kim TH, Cho KH, Pyo HR et al (2005) Dose–volumetric parameters for predicting severe radiation pneumonitis after three-dimensional conformal radiation therapy for lung cancer. Radiology 235:208–215PubMedCrossRef

Tucker SL, Liu HH, Liao Z et al (2008) Analysis of radiation pneumonitis risk using a generalized Lyman model. Int J Radiat Oncol Biol Phys 72:568–574PubMedCrossRef

Roeder F, Friedrich J, Timke C et al (2010) Correlation of patient-related factors and dose–volume histogram parameters with the onset of radiation pneumonitis in patients with small cell lung cancer. Strahlenther Onkol 186:149–156PubMedCrossRef

Blanco AI, Chao KS, El Naqa I et al (2005) Dose–volume modeling of salivary function in patients with head-and-neck cancer receiving radiotherapy. Int J Radiat Oncol Biol Phys 62:1055–1069PubMedCrossRef

Li Y, Taylor JM, Ten Haken RK et al (2007) The impact of dose on parotid salivary recovery in head and neck cancer patients treated with radiation therapy. Int J Radiat Oncol Biol Phys 67:660–669PubMedCrossRef

10.

Tribius S, Sommer J, Prosch C et al (2013) Xerostomia after radiotherapy: what matters—mean total dose or dose to each parotid gland? Strahlenther Onkol 189:216–222PubMedCrossRef

11.

Lambrecht M, Nevens D, Nuyts S (2013) Intensity-modulated radiotherapy vs. parotid-sparing 3D conformal radiotherapy. Effect on outcome and toxicity in locally advanced head and neck cancer. Strahlenther Onkol 189:223–229PubMedCrossRef

12.

Committee E (1997) Report of the expert committee on the diagnosis and classification of diabetes mellitus. Diabetes Care 20:1183–1197

13.

Slezak LA, Andersen DK (2001) Pancreatic resection: effects on glucose metabolism. World J Surg 25:452–460PubMedCrossRef

14.

You DD, Choi SH, Choi DW et al (2012) Long-term effects of pancreaticoduodenectomy on glucose metabolism. ANZ J Surg 82:447–451PubMedCrossRef

15.

Orfanidis NT, Loren DE, Santos C et al (2012) Extended follow-up and outcomes of patients undergoing pancreaticoduodenectomy for nonmalignant disease. J Gastrointest Surg 16:80–87 (discussion 87–88)PubMedCrossRef

16.

Ferrara MJ, Lohse C, Kudva YC et al (2013) Immediate post-resection diabetes mellitus after pancreaticoduodenectomy: incidence and risk factors. HPB (Oxford) 15:170–174

17.

Ishikawa O, Ohigashi H, Eguchi H et al (2004) Long-term follow-up of glucose tolerance function after pancreaticoduodenectomy: comparison between pancreaticogastrostomy and pancreaticojejunostomy. Surgery 136:617–623PubMedCrossRef

18.

Baker KS, Ness KK, Steinberger J et al (2007) Diabetes, hypertension, and cardiovascular events in survivors of hematopoietic cell transplantation: a report from the bone marrow transplantation survivor study. Blood 109:1765–1772PubMedCrossRef

19.

Hoffmeister PA, Storer BE, Sanders JE (2004) Diabetes mellitus in long-term survivors of pediatric hematopoietic cell transplantation. J Pediatr Hematol Oncol 26:81PubMedCrossRef

20.

Neville KA, Cohn RJ, Steinbeck KS et al (2006) Hyperinsulinemia, impaired glucose tolerance, and diabetes mellitus in survivors of childhood cancer: prevalence and risk factors. J Clin Endocrinol Metab 91:4401PubMedCrossRef

21.

Taskinen M, Saarinen-Pihkala UM, Hovi L et al (2000) Impaired glucose tolerance and dyslipidaemia as late effects after bone-marrow transplantation in childhood. Lancet 356:993–997PubMedCrossRef

22.

Sarri Y, Conill C, Verger E et al (1991) Effects of single dose irradiation on pancreatic beta-cell function. Radiother Oncol 22:143–144PubMedCrossRef

23.

Ahmadu-Suka F, Gillette EL, Withrow SJ et al (1988) Pathologic response of the pancreas and duodenum to experimental intraoperative irradiation. Int J Radiat Oncol Biol Phys 14:1197–1204PubMedCrossRef

24.

Meacham LR, Sklar CA, Li S et al (2009) Diabetes mellitus in long-term survivors of childhood cancer: increased risk associated with radiation therapy: a report for the childhood cancer survivor study. Arch Intern Med 169:1381PubMedCrossRef

25.

Kleinerman RA, Weinstock RM, Mabuchi K (2010) High-dose abdominal radiotherapy and risk of diabetes mellitus. Arch Intern Med 170:1506PubMed

26.

Yasugi H, Mlzumoto R, Sakurai H et al (1976) Changes in carbohydrate metabolism and endocrine function of remnant pancreas after major pancreatic resection. Am J Surg 132:577–580PubMedCrossRef

27.

Cameron AJ, Welborn TA, Zimmet PZ et al (2003) Overweight and obesity in Australia: the 1999–2000 Australian Diabetes, Obesity and Lifestyle Study (AusDiab). Med J Aust 178:427–432PubMed

Titel: Postoperative chemoradiotherapy following pancreaticoduodenectomy
Impact of dose–volumetric parameters on the development of diabetes mellitus
verfasst von: K. Eom, M.D.
E.K. Chie, M.D.
K. Kim, M.D.
J.J. Jang, M.D
S.W. Kim, M.D.
D.Y. Oh, M.D.
S.A. Im, M.D.
T.Y. Kim, M.D.
Y.J. Bang, M.D.
S.W. Ha, M.D.
Publikationsdatum: 01.09.2013
Verlag: Springer Berlin Heidelberg
Erschienen in: Strahlentherapie und Onkologie / Ausgabe 9/2013
Print ISSN: 0179-7158
Elektronische ISSN: 1439-099X
DOI: https://doi.org/10.1007/s00066-013-0405-3

Neu im Fachgebiet Onkologie

Umsetzung der POMGAT-Leitlinie läuft

03.05.2024 DCK 2024 Kongressbericht

Seit November 2023 gibt es evidenzbasierte Empfehlungen zum perioperativen Management bei gastrointestinalen Tumoren (POMGAT) auf S3-Niveau. Vieles wird schon entsprechend der Empfehlungen durchgeführt. Wo es im Alltag noch hapert, zeigt eine Umfrage in einem Klinikverbund.

Springer Medizin

Postoperative chemoradiotherapy following pancreaticoduodenectomy

Impact of dose–volumetric parameters on the development of diabetes mellitus