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Cumulative radiation exposure during follow-up after curative surgery for gastric cancer.

Lee YJ, Chung YE, Lim JS, Kim JH, Kim YJ, Lee HJ, You JS, Kim MJ, Kim KW - Korean J Radiol (2012)

Bottom Line: The cED was significantly higher in the advanced (median, 67.0; IQR, 49.1-102.3) than in the early gastric cancer group (median, 52.3; IQR, 41.5-67.9) (p < 0.001), and increased as the TNM stage increased.The cED increases proportionally along with tumor stage and, even in early gastric cancer or stage I patients, cED is much higher than that found among the general population.Considering the very good prognosis of early gastric cancer after curative surgery, the cED should be considered when designing a postoperative follow-up CT protocol.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Yonsei University College of Medicine, Seoul, Korea.

ABSTRACT

Objective: To quantify the cumulative effective dose (cED) of radiation due to repeated CT and PET/CT examinations after curative resection of gastric cancer and to assess the lifetime attributable risk (LAR) estimates based on Biological Effects of Ionizing Radiation VII models.

Subjects and methods: Patients who underwent a curative resection for gastric cancer between January 2006 and December 2006 and were followed-up until May 2010 were included in this study. The cED was calculated by using the dose-length product values and conversion factors for quantitative risk assessment of radiation exposure. cED and LAR were compared between early and advanced gastric cancer patients and among American Joint Committee on Cancer TNM stage groups (stage I, II, and III). The nonparametric Mann-Whitney U and Kruskal-Wallis tests, followed by a post-hoc analysis with Bonferroni adjustment, were employed as part of the statistical analysis.

Results: The overall median cED was 57.8 mSv (interquartile range [IQR], 43.9-74.7). The cED was significantly higher in the advanced (median, 67.0; IQR, 49.1-102.3) than in the early gastric cancer group (median, 52.3; IQR, 41.5-67.9) (p < 0.001), and increased as the TNM stage increased. For radiation exposure, 62% of all patients received an estimated cED of over 50 mSv, while 11% of patients received over 100 mSv. The median LAR of cancer incidence was 0.28% (IQR, 0.20-0.40) and there were significant differences between the early gastric cancer and advanced gastric cancer group (p < 0.001) as well as among the three TNM stage groups (p = 0.015). The LAR of cancer incidence exceeded 1% in 2.4% of the patients.

Conclusion: The cED increases proportionally along with tumor stage and, even in early gastric cancer or stage I patients, cED is much higher than that found among the general population. Considering the very good prognosis of early gastric cancer after curative surgery, the cED should be considered when designing a postoperative follow-up CT protocol.

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Flow chart of patient inclusion, with reason for exclusion and total study population.
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Figure 1: Flow chart of patient inclusion, with reason for exclusion and total study population.

Mentions: Between January 2006 and December 2006, 1124 patients underwent curative surgery for gastric cancer at our institution. Among these patients, eight who had previous or concurrent malignancies were excluded. In total, 99 patients were excluded due to death during the follow-up period. Another 27 patients, who experienced tumor recurrence during follow-up, were also excluded. Of of the remaining 990 patients, 244 were lost to follow-up. An additional 87 patients were excluded because CT dose profile reports were not available in the picture archive and communication system (PACS; Centricity, GE Medical Systems). Twenty-one patients who received neoadjuvant or adjuvant radiotherapy were also excluded, because radiotherapy deliberately uses a very high dose (between 20 to 50 Gy) of radiation to produce deterministic effects (i.e., killing tumor cells). After all, 638 patients (415 men, 223 women; average age, 60.1 years; range, 27-89 years) were included in our study (Fig. 1). Gastric cancer was pathologically confirmed by either a total gastrectomy (n = 194) or subtotal gastrectomy (n = 444). All patients were divided into two groups according to the definitions proposed by the Japanese Research Society for Gastric Cancer as follows: early gastric cancer (EGC), defined as an adenocarcinoma of the stomach confined to the mucosa or submucosa, irrespective of lymph node involvement, as opposed to advanced gastric cancer (AGC), which is beyond the submucosa of the stomach (9). Furthermore, we divided patients into three groups according to TNM stage (Stage I, II, and III) based on the American Joint Committee on Cancer (AJCC) 7th edition (1).


Cumulative radiation exposure during follow-up after curative surgery for gastric cancer.

Lee YJ, Chung YE, Lim JS, Kim JH, Kim YJ, Lee HJ, You JS, Kim MJ, Kim KW - Korean J Radiol (2012)

Flow chart of patient inclusion, with reason for exclusion and total study population.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3303897&req=5

Figure 1: Flow chart of patient inclusion, with reason for exclusion and total study population.
Mentions: Between January 2006 and December 2006, 1124 patients underwent curative surgery for gastric cancer at our institution. Among these patients, eight who had previous or concurrent malignancies were excluded. In total, 99 patients were excluded due to death during the follow-up period. Another 27 patients, who experienced tumor recurrence during follow-up, were also excluded. Of of the remaining 990 patients, 244 were lost to follow-up. An additional 87 patients were excluded because CT dose profile reports were not available in the picture archive and communication system (PACS; Centricity, GE Medical Systems). Twenty-one patients who received neoadjuvant or adjuvant radiotherapy were also excluded, because radiotherapy deliberately uses a very high dose (between 20 to 50 Gy) of radiation to produce deterministic effects (i.e., killing tumor cells). After all, 638 patients (415 men, 223 women; average age, 60.1 years; range, 27-89 years) were included in our study (Fig. 1). Gastric cancer was pathologically confirmed by either a total gastrectomy (n = 194) or subtotal gastrectomy (n = 444). All patients were divided into two groups according to the definitions proposed by the Japanese Research Society for Gastric Cancer as follows: early gastric cancer (EGC), defined as an adenocarcinoma of the stomach confined to the mucosa or submucosa, irrespective of lymph node involvement, as opposed to advanced gastric cancer (AGC), which is beyond the submucosa of the stomach (9). Furthermore, we divided patients into three groups according to TNM stage (Stage I, II, and III) based on the American Joint Committee on Cancer (AJCC) 7th edition (1).

Bottom Line: The cED was significantly higher in the advanced (median, 67.0; IQR, 49.1-102.3) than in the early gastric cancer group (median, 52.3; IQR, 41.5-67.9) (p < 0.001), and increased as the TNM stage increased.The cED increases proportionally along with tumor stage and, even in early gastric cancer or stage I patients, cED is much higher than that found among the general population.Considering the very good prognosis of early gastric cancer after curative surgery, the cED should be considered when designing a postoperative follow-up CT protocol.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Yonsei University College of Medicine, Seoul, Korea.

ABSTRACT

Objective: To quantify the cumulative effective dose (cED) of radiation due to repeated CT and PET/CT examinations after curative resection of gastric cancer and to assess the lifetime attributable risk (LAR) estimates based on Biological Effects of Ionizing Radiation VII models.

Subjects and methods: Patients who underwent a curative resection for gastric cancer between January 2006 and December 2006 and were followed-up until May 2010 were included in this study. The cED was calculated by using the dose-length product values and conversion factors for quantitative risk assessment of radiation exposure. cED and LAR were compared between early and advanced gastric cancer patients and among American Joint Committee on Cancer TNM stage groups (stage I, II, and III). The nonparametric Mann-Whitney U and Kruskal-Wallis tests, followed by a post-hoc analysis with Bonferroni adjustment, were employed as part of the statistical analysis.

Results: The overall median cED was 57.8 mSv (interquartile range [IQR], 43.9-74.7). The cED was significantly higher in the advanced (median, 67.0; IQR, 49.1-102.3) than in the early gastric cancer group (median, 52.3; IQR, 41.5-67.9) (p < 0.001), and increased as the TNM stage increased. For radiation exposure, 62% of all patients received an estimated cED of over 50 mSv, while 11% of patients received over 100 mSv. The median LAR of cancer incidence was 0.28% (IQR, 0.20-0.40) and there were significant differences between the early gastric cancer and advanced gastric cancer group (p < 0.001) as well as among the three TNM stage groups (p = 0.015). The LAR of cancer incidence exceeded 1% in 2.4% of the patients.

Conclusion: The cED increases proportionally along with tumor stage and, even in early gastric cancer or stage I patients, cED is much higher than that found among the general population. Considering the very good prognosis of early gastric cancer after curative surgery, the cED should be considered when designing a postoperative follow-up CT protocol.

Show MeSH
Related in: MedlinePlus