CT 引导下的肾癌冷冻消融术：来自程序和随访影像学的辐射负担以及相关的继发性癌症风险。

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

机构信息

Department of Radiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark.

Medico/Technical Department, Aarhus University Hospital, Aarhus, Denmark.

出版信息

Abdom Radiol (NY). 2020 Nov;45(11):3581-3588. doi: 10.1007/s00261-020-02527-1.

DOI:10.1007/s00261-020-02527-1

PMID:32285178

Abstract

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.

摘要

目的

评估经皮冷冻消融（PCA）治疗小肾肿瘤（SRM）患者的辐射剂量及相关的继发性癌症风险。

方法

本研究共纳入了 149 名在我院接受 PCA 治疗的 SRM 患者。根据 CT 剂量报告，我们计算了 CT 引导下 PCA 手术和消融后 CT 随访的平均有效剂量。根据多学科专家小组的随访建议，我们计算了 PCA 治疗和 CT 监测方案的总辐射剂量，对应最小和最佳随访方案（5 年与 10 年）。根据最新的 BEIR VII 报告，基于累积有效剂量，计算了不同年龄组的终生归因癌症风险。

结果

最小和最佳方案的 PCA 治疗和随访 CT 的总剂量分别为 174 和 294 mSv。最小和最佳方案的随访 CT 占总有效剂量的大部分（89%比 94%）。CT 透视仅对最小和最佳方案的总辐射剂量贡献有限（1.8%比 1.1%）。对于 70 岁的男性患者，当完成最佳随访方案时，其终生归因癌症风险为 0.8%（1/131）。对于 30 岁的女性患者，相同的方案会导致终生归因癌症风险为 3.4%（1/29）。