Korean J Radiol.  2012 Apr;13(2):144-151. 10.3348/kjr.2012.13.2.144.

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

• KMID: 1245378
• DOI: http://doi.org/10.3348/kjr.2012.13.2.144

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.

Keyword

Computed tomography; Effective dose; Lifetime attributable risk; Gastric cancer; Radiation exposure; Follow-up

MeSH Terms

Adult
Aged
Aged, 80 and over
Female
Follow-Up Studies
Gastrectomy
Humans
Male
Middle Aged
Neoplasm Staging
*Positron-Emission Tomography and Computed Tomography
*Radiation Dosage
Retrospective Studies
Risk Assessment
Statistics, Nonparametric
Stomach Neoplasms/pathology/*radiography/*radionuclide imaging/surgery
*Tomography, X-Ray Computed
Treatment Outcome

Figure

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

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  Fig. 2 Histogram of cumulative CT effective dose per patient. Inset includes expanded y-axis to display right tail and contains number of patients who received more than 100 mSv.

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