CT-guided cryoablation of renal cancer: radiation burden and the associated risk of secondary cancer from procedural- and follow-up imaging

TY - JOUR

T1 - CT-guided cryoablation of renal cancer

T2 - radiation burden and the associated risk of secondary cancer from procedural- and follow-up imaging

AU - Borgbjerg, Jens

AU - Bylling, Thóra

AU - Andersen, Gratien

AU - Thygesen, Jesper

AU - Mikkelsen, Anders

AU - Nielsen, Tommy K.

PY - 2020/11

Y1 - 2020/11

N2 - Objectives: To estimate radiation dose and the associated risk of secondary cancer risk related to percutaneous cryoablation (PCA) and follow-up imaging in a cohort of patients treated for small renal masses (SRMs). Methods: A total of 149 patients underwent PCA for a SRM at our institution. Based on CT dose reports, we calculated the mean effective dose for a CT-guided PCA procedure and post-ablative follow-up CT. Applying follow-up recommendations by a multidisciplinary expert panel, we calculated the total radiation dose for the PCA procedure and the CT surveillance program corresponding to a minimal and preferable follow-up regime (5-year vs 10-year). Estimates of the lifetime attributable cancer risk for different age groups were calculated based on the cumulative effective dose based on the latest BEIR VII report. Results: Total dose for the PCA treatment and follow-up CTs amounted to 174 and 294 mSv for a minimal and preferable protocol, respectively. Follow-up CTs accounted for the majority of the total effective dose for the minimal and preferable protocol (89% vs 94%). CT fluoroscopy contributed only to a limited amount of the total radiation dose for the minimal and preferable protocol (1.8% vs 1.1%). A 70-year-old male undergoing PCA treatment has a lifetime attributable cancer risk of 0.8% (1 in 131) when completing the preferable follow-up protocol. The same regimen in a 30-year-old female results in a lifetime attributable risk of cancer of 3.4% (1 in 29). Conclusion: Radiation dose and the associated risk of secondary cancer are high for patients with SRMs undergoing PCA and post-ablative follow-up imaging in particular in younger patients. Radiation exposure in the PCA procedure itself accounts for only a limited amount of the total radiation. Radiologists and clinicians must strive to implement radiation dose saving measures especially with respect to the follow-up regime.

AB - Objectives: To estimate radiation dose and the associated risk of secondary cancer risk related to percutaneous cryoablation (PCA) and follow-up imaging in a cohort of patients treated for small renal masses (SRMs). Methods: A total of 149 patients underwent PCA for a SRM at our institution. Based on CT dose reports, we calculated the mean effective dose for a CT-guided PCA procedure and post-ablative follow-up CT. Applying follow-up recommendations by a multidisciplinary expert panel, we calculated the total radiation dose for the PCA procedure and the CT surveillance program corresponding to a minimal and preferable follow-up regime (5-year vs 10-year). Estimates of the lifetime attributable cancer risk for different age groups were calculated based on the cumulative effective dose based on the latest BEIR VII report. Results: Total dose for the PCA treatment and follow-up CTs amounted to 174 and 294 mSv for a minimal and preferable protocol, respectively. Follow-up CTs accounted for the majority of the total effective dose for the minimal and preferable protocol (89% vs 94%). CT fluoroscopy contributed only to a limited amount of the total radiation dose for the minimal and preferable protocol (1.8% vs 1.1%). A 70-year-old male undergoing PCA treatment has a lifetime attributable cancer risk of 0.8% (1 in 131) when completing the preferable follow-up protocol. The same regimen in a 30-year-old female results in a lifetime attributable risk of cancer of 3.4% (1 in 29). Conclusion: Radiation dose and the associated risk of secondary cancer are high for patients with SRMs undergoing PCA and post-ablative follow-up imaging in particular in younger patients. Radiation exposure in the PCA procedure itself accounts for only a limited amount of the total radiation. Radiologists and clinicians must strive to implement radiation dose saving measures especially with respect to the follow-up regime.

KW - Cryoablation

KW - Radiation

KW - Renal cell carcinoma

KW - Tomography

KW - X-ray computed

KW - Cryosurgery

KW - Follow-Up Studies

KW - Humans

KW - Male

KW - Tomography, X-Ray Computed

KW - Radiation Dosage

KW - Kidney Neoplasms/diagnostic imaging

KW - Adult

KW - Female

KW - Aged

UR - http://www.scopus.com/inward/record.url?scp=85083802534&partnerID=8YFLogxK

U2 - 10.1007/s00261-020-02527-1

DO - 10.1007/s00261-020-02527-1

M3 - Journal article

C2 - 32285178

AN - SCOPUS:85083802534

SN - 2366-004X

VL - 45

SP - 3581

EP - 3588

JO - Abdominal Radiology

JF - Abdominal Radiology

IS - 11

ER -