1303 SIGNIFICANT VARIABILITY IN 10-YEAR CUMULATIVE RADIATION EXPOSURE INCURRED ON DIFFERENT SURVEILLANCE REGIMENS FOLLOWING SURGERY FOR PT1 RENAL CANCERS – YET ANOTHER REASON TO STANDARDIZE PROTOCOLS?

You have accessJournal of UrologyKidney Cancer: Localized II1 Apr 20121303 SIGNIFICANT VARIABILITY IN 10-YEAR CUMULATIVE RADIATION EXPOSURE INCURRED ON DIFFERENT SURVEILLANCE REGIMENS FOLLOWING SURGERY FOR PT1 RENAL CANCERS – YET ANOTHER REASON TO STANDARDIZE PROTOCOLS? Lori Gettle, Yu Kuan Lin, and Jay Raman Lori GettleLori Gettle Hershey, PA More articles by this author , Yu Kuan LinYu Kuan Lin Hershey, PA More articles by this author , and Jay RamanJay Raman Hershey, PA More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.1637AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Population based registries highlight that 25% of patients with newly diagnosed renal tumors will be younger than 55 years of age with a greater than 20-year anticipated life expectancy. Ionizing radiation exposure incurred on surveillance protocols following surgery may be significant in younger patients with earlier stage tumors followed for a longer duration of time. We evaluated the 10-year cumulative radiation exposure incurred on different surveillance regimens following surgery for pT1 renal cell carcinoma (RCC). METHODS The PubMed database was queried to identify surveillance protocols following surgery for early stage RCC. Two index lesions were selected: 1) pT1a 3cm, Fuhrman grade 2, clear cell RCC and 2) pT1b 5cm, Fuhrman grade 3, clear cell RCC. Radiation exposure for a single phase chest CT, abdominal CT, and CXR were determined to be 9.4mSV, 11.7mSV, and 0.13mSV, respectively, based on the average of 3 sources. Calculated exposures assumed that all CT scans were two phase (non-contrast + iodinated contrast), all surgical margins were negative, and performance status was ECOG 0 or 1. RESULTS 12 published surveillance regimens were identified. (Table) For the first index lesion (pT1a, clear cell, Fuhrman 2), we observed significant variability in proposed regimens ranging from no imaging to several CT scans of both the chest and abdomen. Accordingly, the cumulative incurred radiation exposure for this index patient ranged between 0mSv and 140mSv (mean exposure, 47 mSv). When considering the second index tumor (pT1b, clear cell, Fuhrman 3), all studies recommended some form of follow-up imaging although the regimens once again varied from annual CXR to multiple CT scans of the chest and abdomen. As a result, cumulative incurred radiation exposure in this scenario ranged from 1.0 mSv to over 600mSv (mean exposure, 127mSV). Surveillance protocol and cumulative 10-year radiation incurred following surgery for specified index lesions 3cm, pT1a, Clear Cell, Grade 2 3cm, pT1a, Clear Cell, Grade 2 5cm, pT1b, Clear Cell, Grade 3 5 cm pT1b, Clear Cell, Grade 3 Study Protocol Exposure (mSv) Protocol Exposure (mSv) Siddiqui et al. (BJU Int, 2009) 6 Abd CT 140 6 Abd CT, 12 CXR 142 Klatte et al. (Urol Oncol, 2008) 5 Chest CT 94 5 Abd CT, 8 Chest CT 267 Skolarikos et al. (Eur Urol, 2007) 13 CXR 1.7 13 CXR 1.7 Lam at al. (J Urol, 2005) 2 Abd CT, 5 Chest CT 131 5 Abd CT, 10 Chest CT 285 Stephenson et al. (J Urol, 2004) 10 CXR 1.3 10 CXR 1.3 Misckisch et al. (Eur Urol, 2001) 8 CXR 1.0 8 CXR 1.0 Gofrit et al. (Eur Urol, 2001) None 0 15 Abd CT, 15 Chest CT 633 Ljungberg et al. (BJU Int, 1999) None 0 9 CXR 1.2 Levy et al. (J Urol, 1998) 5 CXR 0.7 5 CXR 0.7 Hafez et al. (J Urol, 1997) 5 Abd CT, 10 CXR 118 5 Abd CT, 10 CXR 118 Sandock et al. (J Urol, 1995) 13 CXR 1.7 13 CXR 1.7 Montie (Urol Clin North Am, 1994) 3 Abd CT, 10 CXR 71.5 3 Abd CT, 10 CXR 71.5 CONCLUSIONS A review of 12 surveillance protocols following surgery for early stage RCC reveals disparate regimens with widely divergent levels of radiation exposure to patients. Such considerations are increasingly paramount given contemporary concerns of radiation induced secondary malignancies and present another potential reason to standardize follow-up protocols. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e528 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.Metrics Author Information Lori Gettle Hershey, PA More articles by this author Yu Kuan Lin Hershey, PA More articles by this author Jay Raman Hershey, PA More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...