Dose-dependent changes in renal (1)H-/(23)Na MRI after adjuvant radiochemotherapy for gastric cancer

Recent technical developments and clinical research applications of sodium (23Na) MRI

Sodium is an essential ion that plays a central role in many physiological processes including the transmembrane electrochemical gradient and the maintenance of the body's homeostasis. Due to the crucial role of sodium in the human body, the sodium nucleus is a promising candidate for non-invasively assessing (patho-)physiological changes. Almost 10 years ago, Madelin et al. provided a comprehensive review of methods and applications of sodium (23Na) MRI (Madelin et al., 2014) [1]. More recent review articles have focused mainly on specific applications of 23Na MRI. For example, several articles covered 23Na MRI applications for diseases such as osteoarthritis (Zbyn et al., 2016, Zaric et al., 2020) [2,3], multiple sclerosis (Petracca et al., 2016, Huhn et al., 2019) [4,5] and brain tumors (Schepkin, 2016) [6], or for imaging certain organs such as the kidneys (Zollner et al., 2016) [7], the brain (Shah et al., 2016, Thulborn et al., 2018) [8,9], and the heart (Bottomley, 2016) [10]. Other articles have reviewed technical developments such as radiofrequency (RF) coils for 23Na MRI (Wiggins et al., 2016, Bangerter et al., 2016) [11,12], pulse sequences (Konstandin et al., 2014) [13], image reconstruction methods (Chen et al., 2021) [14], and interleaved/simultaneous imaging techniques (Lopez Kolkovsky et al., 2022) [15]. In addition, 23Na MRI topics have been covered in review articles with broader topics such as multinuclear MRI or ultra-high-field MRI (Niesporek et al., 2019, Hu et al., 2019, Ladd et al., 2018) [16-18]. During the past decade, various research groups have continued working on technical improvements to sodium MRI and have investigated its potential to serve as a diagnostic and prognostic tool. Clinical research applications of 23Na MRI have covered a broad spectrum of diseases, mainly focusing on the brain, cartilage, and skeletal muscle (see Fig. 1). In this article, we aim to provide a comprehensive summary of methodological and hardware developments, as well as a review of various clinical research applications of sodium (23Na) MRI in the last decade (i.e., published from the beginning of 2013 to the end of 2022).

What are the late effects of older gastric cancer survivors? A scoping review

Objective

Older gastric cancer survivors account for a high proportion of cancer survivors. To improve their quality of life, a cancer survivorship care plan with a consideration of the late effects is required. This study aimed to understand the extent and type of evidence in relation to the late effects in older gastric cancer survivors.

Methods

We conducted a scoping review based on the JBI scoping review framework. We explored articles in the Cumulative Index to Nursing and Allied Health Literature (CINAHL), Medical Literature Analysis and Retrieval System Online (MEDLINE), SCOPUS, Web of science, Excerpta Medica dataBASE (EMBASE), Research InformationSharing Service (RISS), Korean Medical dataBASE(KMBase), and National Digital Science Library (NDSL) databases published from January 1, 2012, to December 31, 2021. The keywords used for search are "gastric cancer", "aged", "survivors", and "late effect or long-term effect or late symptom or time factors". While 439 records were initially identified, 14 articles were eventually selected based on the inclusion criteria.

Results

Most studies were conducted in 2019 (4 studies, 28.6%), and more than half (8 studies, 57.1%) were conducted in Asia. In total, six definitions of cancer survivors were found in the studies. The most common age range in the studies was 60-64 years (7 studies, 50.0%). The second primary cancer risk was the most common late effects (5 studies, 20.8%). Among 14 studies, there was only one study of intervention study (7.1%).

Conclusions

It is time to shift the focus from survival to care that improve the quality of life after treatment. We suggest future studies to define cancer survivors, set the age criteria and characterize the late effects in older gastric cancer survivors.

Impact of Radiotherapy on Kidney Function among Patients Who Received Adjuvant Treatment for Gastric Cancer: Logistic and Linear Regression Analyses

We investigated the incidence of renal function impairment after adjuvant treatment for gastric cancer and analyzed the impact of radiotherapy on estimated glomerular filtration rate (eGFR) five years after gastric surgery. We reviewed the medical records of 1490 patients with stomach cancer who underwent curative surgery and adjuvant treatment for gastric cancer. Finally, we included 663 patients who were followed up for ≥5 years without disease recurrence and whose baseline eGFR was ≥60 mL/min/1.73 m2. Logistic and linear regression analyses were performed to determine independent factors associated with the five-year eGFR. A total of 13 (2.0%) patients developed renal function impairment (five-year eGFR <60 mL/min/1.73 m2). In logistic regression analysis, the baseline eGFR was identified as a prognostic factor for renal function impairment (odds ratio (OR), 0.878; 95% confidence interval (CI), 0.831-0.927; p < 0.001), but radiotherapy was not (OR, 1.130; 95% CI, 0.366-3.491; p = 0.832). In linear regression analysis, age (B = -0.350, p < 0.001), baseline eGFR (B = 0.576, p < 0.001), cisplatin (B = -2.056, p = 0.010), and radiotherapy (B = -2.628, p < 0.001) were predictive variables for the five-year eGFR. Among patients who received adjuvant radiotherapy, age (B = -0.277, p < 0.001), hypertension (B = -4.986, p = 0.004), baseline eGFR (B = 0.665, p < 0.001), and volume of the kidneys receiving ≥20 Gy (B = -0.209, p = 0.012) were predictive variables for the five-year eGFR. Development of renal function impairment after adjuvant treatment for gastric cancer was rare among patients with normal baseline kidney function. While radiotherapy was negatively associated with the five-year eGFR, its impact would have been minimal if the kidneys were properly shielded. Further studies are needed to confirm the impact of radiotherapy in patients with poor kidney function.