Cancer Research and Treatment

Original Articles

Pancreatic Irradiation Dose as a Risk Factor for Elevation in Hemoglobin A1c Level and Diabetes Mellitus in Patients with Indolent Gastroduodenal Lymphoma: Jong Yun Baek, Do Hoon Lim, Dongryul Oh, Jae J Kim, Jun Haeng Lee, Byung-Hoon Min, Hyuk Lee; Received June 2, 2025 Accepted July 28, 2025 Published online July 29, 2025; DOI: https://doi.org/10.4143/crt.2025.585 [Epub ahead of print]

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.

Citations

Citations to this article as recorded by

Definitive 24 Gy radiotherapy for stage IE gastric MALT lymphoma: large-scale validation of an optimal dose with reduced acute toxicity
Jong Yun Baek, Do Hoon Lim, Jae J Kim, Jun Haeng Lee, Byung-Hoon Min, Hyuk Lee
Gastric Cancer.2026;[Epub] CrossRef

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Hematologic malignancy

Increased Risk of Diabetes after Definitive Radiotherapy in Patients with Indolent Gastroduodenal Lymphoma: Jong Yun Baek, Do Hoon Lim, Dongryul Oh, Heerim Nam, Jae J Kim, Jun Haeng Lee, Byung-Hoon Min, Hyuk Lee; Cancer Res Treat. 2022;54(1):294-300. Published online April 1, 2021; DOI: https://doi.org/10.4143/crt.2021.073

Abstract PDF Supplementary Material PubReader ePub

Purpose
This study aimed to evaluate the effect of radiotherapy (RT) on the risk of diabetes by assessing hemoglobin A1c (HbA1c) levels in patients with gastroduodenal indolent lymphoma.
Materials and Methods
This retrospective study included patients with stage I extranodal marginal zone lymphoma of the mucosa-associated lymphoid tissue or follicular lymphoma of the gastroduodenal region who were treated with Helicobacter pylori eradication and/or RT between 2000 and 2019 in our institution. Of total 79 patients with HbA1c test, 17 patients received RT (RT group), while 62 patients did not receive RT (control group). A diabetes-associated event (DAE) was defined as a ≥ 0.5% increase in HbA1c levels from baseline, and diabetes event (DE) were defined as HbA1c level of ≥ 6.5%.
Results
During the median follow-up of 49 months, no local failure occurred after RT and no patients died of lymphoma. The RT group had significantly higher risk for DAEs on univariable analysis (hazard ratio [HR], 4.18; 95% confidence interval [CI], 1.64 to 10.66; p < 0.01) and multivariable analysis (HR, 3.68; 95% CI, 1.42 to 9.56; p=0.01). Further, the DE risk was significantly higher in the RT group than in the control group (HR, 4.32; 95% CI, 1.08 to 17.30; p=0.04) and in patients with increased baseline HbA1c levels (HR, 35.83; 95% CI, 2.80 to 459.19; p=0.01). On multivariable analysis, RT significantly increased the risk of DEs (HR, 4.55; 95% CI, 1.08 to 19.19; p=0.04), even after adjusting baseline HbA1c level (HR, 40.97; 95% CI, 3.06 to 548.01; p=0.01).
Conclusion
Patients who received RT for gastroduodenal indolent lymphoma had an increased risk of diabetes compared to those who did not.

Citations

Citations to this article as recorded by

Definitive 24 Gy radiotherapy for stage IE gastric MALT lymphoma: large-scale validation of an optimal dose with reduced acute toxicity
Jong Yun Baek, Do Hoon Lim, Jae J Kim, Jun Haeng Lee, Byung-Hoon Min, Hyuk Lee
Gastric Cancer.2026; 29(2): 376. CrossRef
Transcriptomic insights into the antidiabetic effects of mulberry leaf Fu brick tea in GK rats
Fang Zhou, Ji-ming Jia, Ying Liu, Xuan-yu Liu, Xiang-yang Tang, Jie Qin, Peng-yun Fu, Meng-yao Ma, Hua Fu, Bao-de Zhu, Chang-wei Liu
Journal of Functional Foods.2026; 138: 107212. CrossRef
Nanomedicine-enabled disruption of glucose metabolism and synergistic antitumor therapy
Jiang Ni, Ang Ma, Qiufang Gao, Chenxu Li, Dan Li, Rong Wang, Yang Ding, Hong Cao
Journal of Nanobiotechnology.2026;[Epub] CrossRef
Extracellular Polysaccharides of Eurotium cristatum from Fu Brick Tea Ameliorated Type 2 Diabetes in Mice by Remodeling of Gut Microbiota-Dependent Tryptophan Metabolism to Activate the Hepatic AhR/TSC2/mTORC1 Axis
Zhengwei Tan, Ai Tian, Ruyue Ma, Chengcheng Yang, Xingyu Liu, Lulu Wang, Pengfei Niu, Yan Zhao, Xingbin Yang
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Clinical characteristics of duodenal-type follicular lymphoma
Lu Wang, Wenyan Shen, Xiaoyuan Zhang, Ling Xue, Beili Hu
Discover Oncology.2025;[Epub] CrossRef
Regulatory role of growth factors during N-acetylcysteine administration in the model of radiation-induced pancreatic injury
G. A. Demyashkin, M. A. Vadyukhin, V. I. Shchekin, D. V. Belokopytov
Research and Practical Medicine Journal.2025; 12(4): 56. CrossRef
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Grigoriy Aleksandrovich Demyashkin, Dali Ibragimovna Ugurchieva, Vladislav Andreevich Yakimenko, Matvey Anatol'evich Vadyukhin
Ulyanovsk Medico-biological Journal.2024; (2): 166. CrossRef
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Risk of Diabetes Mellitus after Radiotherapy for Gastric Mucosa-Associated Lymphoid Tissue Lymphoma
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