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Optimized conformal paraaortic lymph node irradiation is not associated with enhanced renal toxicity
Meinhard Nevinny-Stickel1, Karin Poljanc, Britta C Forthuber
1Department of Therapeutic Radiology and Oncology, Innsbruck Medical University, Austria. meinhard.nevinny@uibk.ac.at
Summary
Irradiation of paraaortic lymph nodes (PLNs) for gynecologic cancers is common. This study found that even with high complication probabilities, kidney function remains largely unaffected, validating the safety of this treatment.
Area of Science:
- Oncology
- Radiation Oncology
- Nephrology
Background:
- Paracervical lymph node (PLN) irradiation is a standard treatment for gynecologic carcinomas.
- Individualized planning target volumes (PTVs) ensure coverage of 97% of potentially involved PLNs.
- Concerns exist regarding increased radiation-induced nephrotoxicity with this technique.
Purpose of the Study:
- To assess the incidence of kidney damage after PLN irradiation.
- To validate the safety of current PLN irradiation treatment concepts.
- To evaluate functional renal parameters and clinical outcomes post-irradiation.
Main Methods:
- 19 patients with gynecologic carcinomas received irradiation alone (50.4 Gy).
- Dynamic renal scintigraphy assessed renal plasma flow (RPF) and glomerular filtration rate (GFR).
- Clinical observation and normal-tissue complication probability (NTCP) calculations were performed.
Main Results:
- Two patients with moderate NTCP values showed slightly impaired RPF at follow-up.
- One patient with NTCP > 50% developed notable RPF impairment.
- No patients exhibited impaired GFR or clinical symptoms of renal impairment post-irradiation.
Conclusions:
- Conformal irradiation of retroperitoneal lymph nodes with individual PTV delineation is not associated with clinically relevant kidney functional impairment.
- This technique appears safe for preserving kidney function in patients with gynecologic carcinomas.
- Further validation of safety and efficacy is warranted.
