1. Cumulative Radiation Exposure and Lifetime Cancer Risk in Patients With Tetralogy of Fallot Requiring Early Intervention
- Author
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Jeannette R. Wong-Siegel, MD, MPH, Andrew C. Glatz, MD, MSCE, Courtney McCracken, PhD, Choonsik Lee, PhD, Cari M. Kitahara, PhD, Lene H.S. Veiga, PhD, Yun Zhang, PhD, Bryan H. Goldstein, MD, Christopher J. Petit, MD, Athar M. Qureshi, MD, George T. Nicholson, III, MD, Mark A. Law, MD, Jeffery Meadows, MD, Shabana Shahanavaz, MD, Michael L. O’Byrne, MD, MSCE, Sarosh P. Batlivala, MD, Joelle Pettus, MPH, MS, Asaad Beshish, MD, Christopher E. Mascio, MD, Jennifer C. Romano, MD, Kathyrn O. Stack, MD, Ivor Asztalos, MD, MSCE, Tacy E. Downing, MD, and Jeffrey D. Zampi, MD
- Subjects
congenital heart disease ,cancer ,outcomes ,radiation exposure ,staged repair ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 ,Medical emergencies. Critical care. Intensive care. First aid ,RC86-88.9 - Abstract
Background: 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. Objectives: The purpose of this study was to compare cumulative radiation exposure and associated lifetime attributable risk (LAR) of cancer between treatment strategies in sTOF. Methods: 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. Results: 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; P 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%). Conclusions: 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.
- Published
- 2024
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