Cumulative Radiation Exposure and Lifetime Cancer Risk in Patients With Tetralogy of Fallot Requiring Early Intervention

Overview

Journal JACC Adv

Specialty Cardiology & Vascular Diseases

Date 2024 Sep 18

PMID 39290814

Authors

Jeannette R Wong-Siegel

Andrew C Glatz

Courtney McCracken

Choonsik Lee

Cari M Kitahara

Lene H S Veiga

Yun Zhang

Bryan H Goldstein

Christopher J Petit

Athar M Qureshi

George T Nicholson 3rd

Mark A Law

Jeffery Meadows

Shabana Shahanavaz

Michael L OByrne

Sarosh P Batlivala

Joelle Pettus

Asaad Beshish

Christopher E Mascio

Jennifer C Romano

Kathyrn O Stack

Ivor Asztalos

Tacy E Downing

Jeffrey D Zampi

Affiliations

Soon will be listed here.

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; < 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%).

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.

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