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Postoperative chemoradiotherapy following pancreaticoduodenectomy

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

Postoperative Chemoradiotherapie nach Pankreatikoduodenektomie

Auswirkung von Dosis-Volumen-Parametern auf die Entstehung von Diabetes mellitus

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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 (Dmax), and percentage of volume receiving specific dose or more were obtained from pre- and postoperative CT scan images and treatment plan.

Results

Dmax 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 Dmax 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 Dmax 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.

Zusammenfassung

Ziel

Untersuchung der Beziehung zwischen Dosis-Volumen-Parametern und der Entstehung von Diabetes mellitus (DM) bei Patienten, die nach kurativer Resektion wegen oberer gastrointestinaler (GI) Krebserkrankungen mit Chemoradiotherapie (CRT) behandelt wurden.

Patienten und Methoden

Die Krankenakten von Patienten, die sich zwischen Januar 2006 und Dezember 2008 einer CRT gefolgt von einer kurativen Resektion, entweder einer Duodenopankreatektomie (PD) oder einer pyloruserhaltenden Duodenopankreatektomie (PPPD), wegen Krebserkrankungen im oberen Verdauungstrakt, einschließlich Bauchspeicheldrüsen-, biliärem, Ampullen- und Duodenal-Karzinomen, unterzogen haben, wurden retrospektiv begutachtet. An dieser Untersuchung nahmen 42 Patienten teil, die regelmäßig über mindestens 2 Jahre nachuntersucht wurden. Dosis-Volumen-Parameter, wie restliches Pankreasvolumen, mittlere Dosis, Maximaldosis (Dmax) und Prozentsatz des Volumens, das eine spezifische Dosis erhält, wurden aus prä- und postoperativen CT-Bildern und dem Behandlungsplan gewonnen.

Ergebnisse

Dmax und V50 (prozentualer Anteil, der mindestens 50 Gy erhält) waren statistisch signifikante Faktoren für die Entstehung von DM (p = 0,013 bzw. p = 0,031). Die Sensitivität und Spezifizität von Dmax lag bei 0,875 bzw. bei 0,559 mit einem Cutoff von 51,1 Gy. V50 hatte eine Sensitivität von 0,875 und eine Spezifizität von 0,618 für den Cutoff von 16 %. Kein anderer patientenbezogener Faktor als die vor der Behandlung auftretenden zerebrovaskulären Ereignisse wurde mit der Entstehung von DM assoziiert. In der multivariaten Analyse war V50 der einzige Faktor mit statistischer Signifikanz (p = 0,028), während Dmax grenzwertig signifikant war (p = 0,079).

Schlussfolgerung

V50 war der einzige unabhängige Faktor, der mit der Entwicklung von DM assoziiert war und als Richtschnur angesehen werden kann, mit deren Hilfe das Entstehen von DM bei Patienten, die nach kurativer Resektion mit CRT behandelt wurden, vorhergesagt werden kann.

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Conflict of interest

On behalf of all authors, the corresponding author states that there are no conflicts of interest.

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Authors and Affiliations

  1. Department of Radiation Oncology, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, 110–744, Seoul, Korea

    K. Eom M.D., E.K. Chie M.D., K. Kim M.D. & S.W. Ha M.D.

  2. Department of Surgery, Seoul National University College of Medicine, Seoul, Korea

    J.J. Jang M.D & S.W. Kim M.D.

  3. Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea

    D.Y. Oh M.D., S.A. Im M.D., T.Y. Kim M.D. & Y.J. Bang M.D.

  4. Institute of Radiation Medicine, Medical Research Center, Seoul National University, Seoul, Korea

    E.K. Chie M.D. & S.W. Ha M.D.

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  1. K. Eom M.D.
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Correspondence to E.K. Chie M.D..

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Eom, K., Chie, E., Kim, K. et al. Postoperative chemoradiotherapy following pancreaticoduodenectomy . Strahlenther Onkol 189, 753–758 (2013). https://doi.org/10.1007/s00066-013-0405-3

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