Wong-Siegel Jeannette R, Glatz Andrew C, McCracken Courtney, Lee Choonsik, Kitahara Cari M, Veiga Lene H S, Zhang Yun, Goldstein Bryan H, Petit Christopher J, Qureshi Athar M, Nicholson George T, Law Mark A, Meadows Jeffery, Shahanavaz Shabana, O'Byrne Michael L, Batlivala Sarosh P, Pettus Joelle, Beshish Asaad, Mascio Christopher E, Romano Jennifer C, Stack Kathyrn O, Asztalos Ivor, Downing Tacy E, Zampi Jeffrey D
The Heart Center, St. Louis Children's Hospital, Washington University School of Medicine, St. Louis, Missouri, USA.
Center for Research and Evaluation, Kaiser Permanente, Atlanta, Georgia, USA.
JACC Adv. 2024 Sep 6;3(10):101239. doi: 10.1016/j.jacadv.2024.101239. eCollection 2024 Oct.
Neonates with tetralogy of Fallot and symptomatic cyanosis (sTOF) require early intervention, utilizing either a staged repair (SR) or primary repair (PR) approach. They are exposed to several sources of low-dose ionizing radiation, which may contribute to increased cancer risk.
The purpose of this study was to compare cumulative radiation exposure and associated lifetime attributable risk (LAR) of cancer between treatment strategies in sTOF.
Neonates with sTOF who underwent SR or PR from 2012 to 2017 were retrospectively reviewed from the Congenital Cardiac Research Collaborative. Radiation exposure from all radiologic studies prior to 18 months of age was converted to organ-equivalent doses and projected LAR of cancer incidence using the National Cancer Institute dosimetry tools.
There were 242 neonates from 8 centers, including patients with 146 SR and 96 PR. Cumulative total effective dose was significantly higher for SR (median 8.3 mSv, IQR: 3.0-17.4 mSv) than PR (2.1 mSv, IQR: 0.8-8.5 mSv; < 0.001). Cumulative organ-level doses were significantly higher in SR compared to PR. Regardless of treatment strategy, LARs were higher in females compared to males. Among organs with median exposure >1 mGy in females, the LAR was highest for breast in SR (mean 1.9/1,000 patients). The highest proportion of cancers attributable to radiation exposure was projected for thyroid cancer in females undergoing SR (7.3%).
Cumulative radiation exposure and LARs were higher among those undergoing SR compared to PR. This will be an important factor to consider in determining the preferred neonatal treatment strategy and should substantiate efforts to reduce radiation exposure in this vulnerable population.
患有法洛四联症且有症状性发绀（sTOF）的新生儿需要早期干预，采用分期修复（SR）或一期修复（PR）方法。他们会接触到多种低剂量电离辐射源，这可能会增加患癌风险。
本研究的目的是比较sTOF治疗策略之间的累积辐射暴露及相关的终生归因癌症风险（LAR）。
对2012年至2017年接受SR或PR的sTOF新生儿进行先天性心脏病研究协作组的回顾性研究。将18个月龄之前所有放射学检查的辐射暴露转换为器官等效剂量，并使用美国国立癌症研究所剂量测定工具预测癌症发病率的LAR。
来自8个中心的242例新生儿，包括146例接受SR的患者和96例接受PR的患者。SR的累积总有效剂量（中位数8.3 mSv，IQR：3.0 - 17.4 mSv）显著高于PR（2.1 mSv，IQR：0.8 - 8.5 mSv；P < 0.001）。与PR相比，SR的累积器官水平剂量显著更高。无论治疗策略如何，女性的LAR均高于男性。在女性中，中位暴露>1 mGy的器官中，SR中乳房的LAR最高（平均1.9/1000例患者）。接受SR的女性中，归因于辐射暴露的癌症比例最高的是甲状腺癌（7.3%）。
与PR相比，接受SR的患者累积辐射暴露和LAR更高。这将是确定首选新生儿治疗策略时需要考虑的重要因素，并且应切实努力减少这一脆弱人群的辐射暴露。
