Safety of radiotherapy for hemodialysis patients with cancer

Recurrence of hepatocellular carcinoma after radiofrequency ablation in a poor-risk patient with chronic renal failure and other complications successfully treated with stereotactic body radiotherapy

The patient was an 85-year-old man with hepatitis C-related liver cirrhosis and chronic renal failure caused by diabetes mellitus under maintenance hemodialysis (HD) who developed hepatocellular carcinoma (HCC) after achieving a sustained viral response with direct acting antiviral therapy 1 year and 3 months previously. HCC located near the right hepatic vein was treated by radiofrequency ablation (RFA) but recurrent disease accompanied by hepatic vein invasion was detected 3 months after RFA. The recurrent HCC was curatively treated with stereotactic body radiotherapy (SBRT). The patient had additional complications, including grade III AV block controlled by a pacemaker, colonic adenoma resected by endoscopic mucosal resection, and a small cerebral aneurysm, which was untreated. At 2 years after SBRT, there had been no recurrence of HCC. In this old HCC patient with various complications including HD with polypharmacy, multidisciplinary treatment, including SBRT, enabled the patient to achieve complete remission and maintain a good quality of life.

Stage at Diagnosis and Prognosis of Colorectal, Stomach, Lung, Liver, Kidney, and Bladder Cancers in Dialysis Patients: A Multicenter Retrospective Study Using Cancer Registry Data and Administrative Data

<b><i>Background:</i></b> Cancer is an important comorbidity that can affect survival in dialysis patients. However, it is unclear if dialysis patients who develop cancer are disadvantaged by later detection and poorer prognosis. This study comparatively examined the stage at diagnosis and prognosis of several common cancer types in dialysis and nondialysis patients. <b><i>Methods:</i></b> In this retrospective cohort study, cancer registry data were linked with administrative data to identify dialysis and nondialysis patients with any new diagnosis of cancer between 2010 and 2015 at 36 hospitals in Osaka Prefecture, Japan. In these patients, we identified the cancer stage at diagnosis for patients with colorectal, stomach, lung, liver, kidney, and bladder cancers. The association between dialysis and survival time (up to 3 years of follow-up) was examined for each cancer type using Cox proportional hazards models that adjusted for age, sex, and cancer stage. <b><i>Results:</i></b> We analyzed 2,161 dialysis patients and 158,964 nondialysis patients with cancer. Dialysis patients had a higher prevalence of colorectal, liver, and kidney cancers than nondialysis patients. Colorectal, stomach, lung, liver, and kidney cancers were diagnosed earlier in dialysis patients, whereas bladder cancer was diagnosed at an advanced stage. The Cox proportional hazards models revealed that mortality was significantly higher in dialysis patients with colorectal, stomach, lung, and bladder cancers than in nondialysis patients (all <i>p</i> &#x3c; 0.05). <b><i>Conclusions:</i></b> Dialysis patients had higher mortality for several common cancers despite their earlier detection. This poorer prognosis may be influenced by the unavailability and complications of cancer treatment for these patients.

Esophageal Cancer Surgery in Dialyzed Patients: A Single Institution Case Series

We sought to evaluate the feasibility of esophageal carcinoma (EC) surgery in cases requiring dialysis. Among 250 consecutive patients undergoing surgical resection for EC, three on maintenance dialysis were identified. We retrospectively analyzed their clinical characteristics. The three dialyzed patients were all males, 39–77 years old at EC surgery. The operations were thoracoscopic esophagectomy with nodal clearance (Case 1), cervical esophageal resection without thoracic procedures (Case 2), and thoracoscopic esophagectomy without reconstruction, emergently conducted for tumor bleeding (Case 3). Reoperation had been required for postoperative abdominal hematoma in Case 1. Postoperative tracheostomy had been performed due to severe pneumonia in Case 2. EC surgery for dialyzed patients, despite appearing to be feasible, might be associated with a high risk of life-threatening morbidities. To minimize surgical risk, therapeutic decision-making for such cases should be based on the balance between radicality and safety.