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Abstract
Purpose: This study investigated the association between pancreatic irradiation dose and hemoglobin A1c (HbA1c) elevation in patients with indolent gastroduodenal lymphomas treated with radiotherapy (RT).

Materials and methods: We retrospectively reviewed 103 patients treated at Samsung Medical Center between 2010 and 2023, with or without RT. Patients were stratified by mean pancreas dose (< 2,300 cGy vs. ≥ 2,300 cGy). The primary outcome was the 2-year HbA1c elevation, with additional time-to-event analyses for HbA1c elevation ≥ 0.5% and diabetes mellitus (DM) development.

Results: RT was administered to 62 (60.2%) patients, while 41 (39.8%) did not receive RT. There was no significant difference in baseline characteristics except for cancer type. Patients with a mean pancreas dose ≥ 2,300 cGy had a significantly greater 2-year HbA1c increase than those receiving < 2,300 cGy (p=0.003) or no RT (p < 0.001). No significant difference was found between patients receiving < 2,300 cGy and those without RT (p=0.120). In multivariate time-to-event analysis, a mean pancreas dose ≥ 2,300 cGy was the sole significant risk factor for an HbA1c increase ≥ 0.5% (p < 0.001), while mean pancreas dose < 2,300 cGy did not show a significant effect (p=0.851). Furthermore, a mean pancreas dose ≥ 2,300 cGy (p=0.017) and baseline prediabetes (HbA1c ≥ 5.7%) (p=0.023) were independent predictors of DM development.

Conclusion: A mean pancreas dose ≥ 2,300 cGy was associated with HbA1c elevation, whereas doses < 2,300 cGy had minimal effect. Given the established link between higher HbA1c level and increased risk of DM and cardiovascular events, pancreatic dose reduction should be considered in RT planning for patients with an expected good prognosis.

Affiliations

Jong Yun Baek 1, Do Hoon Lim 2, Dongryul Oh 1, Jae J Kim 3, Jun Haeng Lee 3, Byung-Hoon Min 3, Hyuk Lee 3
1Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
2Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. dh8lim@skku.edu.
3Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.