Risk of Diabetes Mellitus after Radiotherapy for Gastric Mucosa-Associated Lymphoid Tissue Lymphoma

SIMPLE SUMMARY: In patients with gastric mucosa-associated lymphoid tissue lymphoma (GML), irradiation of the pancreas is inevitable owing to its anatomical proximity to the stomach. This is the first study to demonstrate the association between RT exposure and the risk of development of diabetes mellitus (DM) in patients with GML by measuring individual-based dose parameters of the pancreas. The findings of this study demonstrate the association between incidental pancreatic irradiation and DM. Obesity and sex were key risk factors for DM. Considering the risk of DM, the pancreas should no longer be neglected during RT planning, particularly in male patients and patients with obesity. ABSTRACT: The long-term effect of radiation on the pancreas in pediatric patients has been studied without individual radiation dosimetric data. This study investigated the effect of radiotherapy on the risk of developing diabetes mellitus (DM) in patients with gastric mucosa-associated lymphoid tissue lymphoma (GML), using individual radiation dosimetric analysis. Retrospective analysis reviewed the data of 225 patients without a history of DM receiving curative treatment for stage IE GML. Involved-site radiotherapy was delivered to the whole stomach in 83 patients. The pancreas was delineated in each patient’s computed tomography scan for dosimetric analysis. At a median follow-up of 49.0 months, the 5-year cumulative incidence of DM was 4.5%, 9.6%, and 1.6% in all patients, patients who received radiotherapy, and patients who did not receive radiotherapy, respectively (p = 0.009). Mean pancreatic dose (D(mean); p = 0.009), sex (p = 0.043), and body mass index (BMI; p = 0.008) were independently associated with DM. Using recursive partitioning analysis, patients were classified into low, intermediate, and high-risk groups, with 5-year DM incidence rates of 0.0%, 3.1%, and 15.6%, respectively (p < 0.001). Incidental irradiation of the pancreas can increase the risk of DM, which may be stratified according to patient sex and BMI.