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

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; Jeffrey D. Zampi, MD

JACC: Advances (Oct 2024)

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

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,
Jeffrey D. Zampi, MD

Affiliations

Jeannette R. Wong-Siegel, MD, MPH: The Heart Center, St. Louis Children’s Hospital, Washington University School of Medicine, St. Louis, Missouri, USA
Andrew C. Glatz, MD, MSCE: The Heart Center, St. Louis Children’s Hospital, Washington University School of Medicine, St. Louis, Missouri, USA; Address for correspondence: Dr Andrew Glatz, Washington University School of Medicine, Department of Pediatrics, Division of Cardiology, 660 South Euclid Ave., MSC 8116-0043-08, St. Louis, Missouri 63110, USA.
Courtney McCracken, PhD: Center for Research and Evaluation, Kaiser Permanente, Atlanta, Georgia, USA
Choonsik Lee, PhD: Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institute of Health, Rockville, Maryland, USA
Cari M. Kitahara, PhD: Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institute of Health, Rockville, Maryland, USA
Lene H.S. Veiga, PhD: Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institute of Health, Rockville, Maryland, USA
Yun Zhang, PhD: New York-Presbyterian Morgan Stanley Children’s Hospital, Columbia University Vagelos College of Physicians & Surgeons, New York, New York, USA
Bryan H. Goldstein, MD: Heart Institute, UPMC Children’s Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
Christopher J. Petit, MD: New York-Presbyterian Morgan Stanley Children’s Hospital, Columbia University Vagelos College of Physicians & Surgeons, New York, New York, USA
Athar M. Qureshi, MD: The Lillie Frank Abercrombie Division of Cardiology, Texas Children’s Hospital, Baylor College of Medicine, Houston, Texas, USA
George T. Nicholson, III, MD: Division of Pediatric Cardiology, Monroe Carell Jr. Children's Hospital at Vanderbilt University Medical Center, Nashville, Tennessee, USA
Mark A. Law, MD: Children’s of Alabama, University of Alabama at Birmingham, Birmingham, Alabama, USA
Jeffery Meadows, MD: Department of Pediatrics, University of California San Francisco, San Francisco, California, USA
Shabana Shahanavaz, MD: Heart Institute, Cincinnati Children’s Hospital, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
Michael L. O’Byrne, MD, MSCE: The Children's Hospital of Philadelphia and Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
Sarosh P. Batlivala, MD: Heart Institute, Cincinnati Children’s Hospital, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
Joelle Pettus, MPH, MS: Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Georgia, USA
Asaad Beshish, MD: Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Georgia, USA
Christopher E. Mascio, MD: West Virginia University Medicine Children's Hospital, Morgantown, West Virginia, USA
Jennifer C. Romano, MD: C.S. Mott Children’s Hospital, University of Michigan School of Medicine, Ann Arbor, Michigan, USA
Kathyrn O. Stack, MD: The Children's Hospital of Philadelphia and Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
Ivor Asztalos, MD, MSCE: The Children's Hospital of Philadelphia and Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
Tacy E. Downing, MD: Division of Cardiology, Children’s National Hospital, Washington, DC, USA
Jeffrey D. Zampi, MD: C.S. Mott Children’s Hospital, University of Michigan School of Medicine, Ann Arbor, Michigan, USA

Journal volume & issue: Vol. 3, no. 10
p. 101239

Abstract

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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 in JACC: Advances

ISSN: 2772-963X (Online)
Publisher: Elsevier
Country of publisher: United States
LCC subjects: Medicine: Internal medicine: Specialties of internal medicine: Diseases of the circulatory (Cardiovascular) system; Medicine: Internal medicine: Medical emergencies. Critical care. Intensive care. First aid
Website: https://www.sciencedirect.com/journal/jacc-advances

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