Radiation exposure from CT-guided ablation of renal masses: effects on life expectancy
Authors
Eisenberg, Jonathan D.Gervais, Debra A.
Singh, Sarabjeet
Kalra, Mannudeep K.
Sabir, Sharjeel H.
Paul, Aaron B.
Pandharipande, Pari V.
Faculty Advisor
Pari Pandharipande, MD, MPH/Mass. General Hospital – Institute for Technology AssessmentDocument Type
Journal ArticlePublication Date
2015-02-01Keywords
AgedCarcinoma, Renal Cell
Catheter Ablation
Female
Humans
Kidney Neoplasms
*Life Expectancy
Male
Neoplasms, Radiation-Induced
Radiation Dosage
Risk Assessment
*Surgery, Computer-Assisted
Tomography, X-Ray Computed
Neoplasms
Radiology
Metadata
Show full item recordAbstract
OBJECTIVE. The purpose of this article is to project the effects of radiation exposure on life expectancy (LE) in patients who opt for CT-guided radiofrequency ablation (RFA) instead of surgery for renal cell carcinoma (RCC). MATERIALS AND METHODS. We developed a decision-analytic Markov model to compare LE losses attributable to radiation exposure in hypothetical 65-year-old patients who undergo CT-guided RFA versus surgery for small ( < /= 4 cm) RCC. We incorporated mortality risks from RCC, radiation-induced cancers (for procedural and follow-up CT scans), and all other causes; institutional data informed the RFA procedural effective dose. Radiation-induced cancer risks were generated using an organ-specific approach. Effects of varying model parameters and of dose-reduction strategies were evaluated in sensitivity analysis. RESULTS. Cumulative RFA exposures (up to 305.2 mSv for one session plus surveillance) exceeded those from surgery (up to 87.2 mSv). In 65-year-old men, excess LE loss from radiation-induced cancers, comparing RFA to surgery, was 11.7 days (14.6 days for RFA vs 2.9 days for surgery). Results varied with sex and age; this difference increased to 14.6 days in 65-year-old women and to 21.5 days in 55-year-old men. Dose-reduction strategies that addressed follow-up rather than procedural exposure had a greater impact. In 65-year-old men, this difference decreased to 3.8 days if post-RFA follow-up scans were restricted to a single phase; even elimination of RFA procedural exposure could not achieve equivalent benefits. CONCLUSION. CT-guided RFA remains a safe alternative to surgery, but with decreasing age, the higher burden of radiation exposure merits explicit consideration. Dose-reduction strategies that target follow-up rather than procedural exposure will have a greater impact.Source
AJR Am J Roentgenol. 2015 Feb;204(2):335-42. doi: 10.2214/AJR.14.13010. Link to article on publisher's siteDOI
10.2214/AJR.14.13010Permanent Link to this Item
http://hdl.handle.net/20.500.14038/49285PubMed ID
25615756Notes
Jonathan Eisenberg participated in this study as a medical student as part of the Senior Scholars research program at the University of Massachusetts Medical School.
Related Resources
Link to Article in PubMedae974a485f413a2113503eed53cd6c53
10.2214/AJR.14.13010