open access

Vol 25, No 4 (2020)
Original research articles
Published online: 2020-07-01
Submitted: 2019-10-04
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Pelvic radiation therapy with volumetric modulated arc therapy and intensity-modulated radiotherapy after renal transplant: A report of 3 cases

Pérez Álvarez Ileana, Ramos Prudencio Rubi, Lozano Ruiz Javier, Macías González Sagrario, Flores Balcazar Haydeé
DOI: 10.1016/j.rpor.2020.04.003
·
Rep Pract Oncol Radiother 2020;25(4):548-555.

open access

Vol 25, No 4 (2020)
Original research articles
Published online: 2020-07-01
Submitted: 2019-10-04

Abstract

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 <4 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.

Abstract

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 <4 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.

Get Citation

Keywords

Renal transplant; Kidney allograft; Prostate cancer; Vaginal cancer; Pelvic radiotherapy; BF; BT; C3D-RT; CBCT; CCa; Dmax; Dmean; Dmin; Dx; EBRT; EQD2; ESKD; fr; FU; HPV; IBT; IMRT; KT; LRDRT; MMF; mo; NED; OAR; OS; PCa; PDN; PP; PSA; PTV; RR; RT; SCCVa; SIR; TBI; VCa; VMAT; Vx

About this article
Title

Pelvic radiation therapy with volumetric modulated arc therapy and intensity-modulated radiotherapy after renal transplant: A report of 3 cases

Journal

Reports of Practical Oncology and Radiotherapy

Issue

Vol 25, No 4 (2020)

Pages

548-555

Published online

2020-07-01

DOI

10.1016/j.rpor.2020.04.003

Bibliographic record

Rep Pract Oncol Radiother 2020;25(4):548-555.

Keywords

Renal transplant
Kidney allograft
Prostate cancer
Vaginal cancer
Pelvic radiotherapy
BF
BT
C3D-RT
CBCT
CCa
Dmax
Dmean
Dmin
Dx
EBRT
EQD2
ESKD
fr
FU
HPV
IBT
IMRT
KT
LRDRT
MMF
mo
NED
OAR
OS
PCa
PDN
PP
PSA
PTV
RR
RT
SCCVa
SIR
TBI
VCa
VMAT
Vx

Authors

Pérez Álvarez Ileana
Ramos Prudencio Rubi
Lozano Ruiz Javier
Macías González Sagrario
Flores Balcazar Haydeé

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