Current Opinions on Medical Radiation: A Survey of Oncologists Regarding Radiation Exposure and Dose Reduction in Oncology Patients

Burke, Lauren M. B.; Bashir, Mustafa R.; Neville, Amy; Nelson, Rendon C.; Jaffe, Tracy A.

doi:10.1016/j.jacr.2013.08.018

Cited by 6 publications

(5 citation statements)

References 42 publications

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“…This topic is of increasing concern among patients and radiologists alike. 25 Routine surveillance imaging in early-stage cHL does not appear meaningful or necessary. However, when pretest probability and clinical suspicion for relapse are strong, it would appear most meaningful to employ PET/CT (rather than CT only) as the single test with the highest expected utility.…”

Section: Discussionmentioning

confidence: 99%

“…[18][19][20][21][22][23][24] The increasing use of medical imaging has also led to concerns about the potential long-term biologic effects of ionizing radiation, particularly in young patients with early-stage cHL who have a high probability of long-term survival. 1,25,26 On the basis of our prior work, 27 we investigated the utility of any surveillance imaging in patients with early-stage cHL treated with CMT who achieved a complete metabolic response according to either interim or postchemotherapy PET/CT.…”

Section: Introductionmentioning

confidence: 99%

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Very low utility of surveillance imaging in early‐stage classic Hodgkin lymphoma treated with a combination of doxorubicin, bleomycin, vinblastine, and dacarbazine and radiation therapy

Gandikota

Hartridge-Lambert

Migliacci

et al. 2015

Cancer

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BACKGROUND This study evaluated the need for surveillance imaging in early-stage classic Hodgkin lymphoma (cHL) after planned combined-modality therapy (CMT). METHODS Primary early-stage cHL patients who underwent CMT were included. Positron emission tomography (PET)/computed tomography (CT), CT, or both were performed at the initial staging, during or after chemotherapy, and for at least 2 years during follow-up. Imaging studies and medical records were reviewed to determine if and when relapse had occurred. Radiation doses and costs were also calculated from follow-up imaging. RESULTS The study included 78 patients with a median follow-up of 46 months; 85% of the patients had stage II disease (32% with bulky disease). Four of 77 interim PET scans were positive; none of these patients relapsed during follow-up, which ranged from 24 to 80 months. After a total of 466 follow-up imaging studies (91% with CT and 9% with PET/CT), no cHL relapse was detected. Eleven abnormal findings were noted on surveillance imaging: 9 were false-positives, and 2 were second primary malignancies. The average cumulative dose per patient from follow-up imaging was 107 mSv, which translated into an estimated lifetime excess cancer risk of 0.5%; the estimated total costs were $296,817 according to Medicare reimbursements. CONCLUSIONS Surveillance imaging with either CT or PET/CT can be omitted safely for early-stage cHL treated with a combination of doxorubicin, bleomycin, vinblastine, and dacarbazine and radiation therapy because the risk of relapse is extremely low. This observation also applies to patients with bulky disease. The elimination of surveillance imaging will also reduce healthcare expenses and cumulative radiation doses in these predominantly young patients.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Very low utility of surveillance imaging in early‐stage classic Hodgkin lymphoma treated with a combination of doxorubicin, bleomycin, vinblastine, and dacarbazine and radiation therapy

Gandikota

Hartridge-Lambert

Migliacci

et al. 2015

Cancer

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“…predominantly due to direct volume measurement without geometric assumptions. 81e84 Non-ionising radiation modalities may be most appropriate due to concerns regarding cumulative radiation dose in cancer patients, 85 as traditional MUGA scanning can expose patients to significant radiation with each exam. 86 It is also recognised that echocardiography provides substantial additional information on cardiac structure, valve function, haemodynamics and physiology not typically found with MUGA scanning.…”

Section: Annals Of Oncologymentioning

confidence: 99%

Management of cardiac disease in cancer patients throughout oncological treatment: ESMO consensus recommendations

et al. 2020

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Cancer and cardiovascular (CV) disease are the most prevalent diseases in the developed world. Evidence increasingly shows that these conditions are interlinked through common risk factors, coincident in an ageing population, and are connected biologically through some deleterious effects of anticancer treatment on CV health. Anticancer therapies can cause a wide spectrum of short-and long-term cardiotoxic effects. An explosion of novel cancer therapies has revolutionised this field and dramatically altered cancer prognosis. Nevertheless, these new therapies have introduced unexpected CV complications beyond heart failure. Common CV toxicities related to cancer therapy are defined, along with suggested strategies for prevention, detection and treatment. This ESMO consensus article proposes to define CV toxicities related to cancer or its therapies and provide guidance regarding prevention, screening, monitoring and treatment of CV toxicity. The majority of anticancer therapies are associated with some CV toxicity, ranging from asymptomatic and transient to more clinically significant and long-lasting cardiac events. It is critical however, that concerns about potential CV damage resulting from anticancer therapies should be weighed against the potential benefits of cancer therapy, including benefits in overall survival. CV disease in patients with cancer is complex and treatment needs to be individualised. The scope of cardio-oncology is wide and includes prevention, detection, monitoring and treatment of CV toxicity related to cancer therapy, and also ensuring the safe development of future novel cancer treatments that minimise the impact on CV health. It is anticipated that the management strategies discussed herein will be suitable for the majority of patients. Nonetheless, the clinical judgment of physicians remains extremely important; hence, when using these best clinical practices to inform treatment options and decisions, practitioners should also consider the individual circumstances of their patients on a case-by-case basis.

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“…Csak a válaszadók 25%-át aggasztotta az, hogy alacsony dózisú CT-vel a kis laesiók diagnosztikája bizonytalan lehet, 63%-uk követte az NCCN-ajánlást, míg 37%-uk más irányelveket vagy a klinikai vizsgálatok előírásait vette figyelembe. Többsé-gük úgy vélte, hogy alacsony dózisú CT-t kell alkalmazni: gyermekeknél, fiatal nőknél, a nem szokványosan a májba metasztatizáló daganatoknál és a rendszeres ellenőrzés alatt álló pácienseknél [1].…”

Section: öSszefoglaló Közleményunclassified

Onkológiai betegek szoros képalkotó követése – előny vagy hátrány?

Deme¹,

Telekes

2016

Orvosi Hetilap

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A Nemzetközi Sugárvédelmi Bizottság becslése szerint 100 mSv sugárexpozíció a rosszindulatú daganatos megbetegedések kockázatát 0,5%-kal emeli. A lineáris nincs küszöb modell központi feltételezése az, hogy alacsony dózisú ionizáló sugárzás esetén a carcinogenesis beindítása az "egy találat akció" során, vagyis akár egy elektron által okozott egy vagy több dezoxiribonukleinsav szál törése útján is megtörténhet. Függetlenül attól, hogy milyen kis dózisról van szó, a sugárexpozíció fokozza a rosszindulatú daganat kialakulásának kockázatát. Az Egyesült Államokban végzett összes komputertomográfiás vizsgálat megközelítőleg egyharmadában egyrészt bizonyított klinikai racionalitás nélkül indikálják a vizsgálatot, azaz olyankor, amikor a nem röntgensugárt alkalmazó képalkotók ugyanolyan szenzitivitással és specificitással használhatóak lennének, másrészt feleslegesen ismétlik a vizsgálatokat. A technikai fejlesztések csök-kentették a sugárterhelés veszélyérzetét, pedig annak kockázatára és kumulatív jellegére mindig gondolni kell. Az onkológiai betegek követésében az ionizáló sugárzással járó rákkockázat minimalizálása szükséges. A nem ionizáló sugárral dolgozó diagnosztikus eszközök széles körű elérhetőségére van szükség (például teljes test diffúziósúlyozott mágneses rezonanciás vizsgálat, pozitronemissziós tomográfia/mágneses rezonanciás vizsgálat). Orv. Hetil., 2016, 157(39), 1538-1545. Kulcsszavak: ionizáló sugárzás, rákkockázat, képalkotó követésClose follow-up of oncologic patients with imaging -advantage or disadvantage?The International Commission on Radiological Protection estimates, that 100 mSv exposure of radiation increases cancer risk by 0.5%. The central hypothesis of the Linear No Threshold model is that low dose ionizing radiation can induce carcinogenesis through the so called "one hit action", that is one or more deoxyribonucleic acid strands can be broken by the hit of only one electron particule. Regardless of the radiation dose, radiation exposure increases cancer risk. In the United States of America, one-third of computed tomographic scans are carried with no clear clinical indication, i.e. non radiating imaging can be applied with equal sensitivity and specificity. Furthermore, computed tomographic scans are repeated unnecessarily. Although technical improvements have reduced the concern of the potential danger of radiation exposure, the cumulative aspects and cancer risk should always be considered. Cancer risk, accompanied by ionizing radiation, should be minimized during the follow up of oncologic patients. It is mandatory, that all diagnostic tools which are not using ionizing radiation should be made widely accessable (eg. whole body diffusion weighted magnetic resonance imaging, positron emission tomography/magnetic resonance imaging). Keywords ÖSSZEFOGLALÓ KÖZLEMÉNYRövidítések ASIR = adaptive statistical iterative reconstruction; BEIR = biological effect of ionizing radiation; c-RET = rearranged during transfection c típusú protoonkogén; CT = computed tomography; DNS = dezoxiribonukle...

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Current Opinions on Medical Radiation: A Survey of Oncologists Regarding Radiation Exposure and Dose Reduction in Oncology Patients

Cited by 6 publications

References 42 publications

Very low utility of surveillance imaging in early‐stage classic Hodgkin lymphoma treated with a combination of doxorubicin, bleomycin, vinblastine, and dacarbazine and radiation therapy

Very low utility of surveillance imaging in early‐stage classic Hodgkin lymphoma treated with a combination of doxorubicin, bleomycin, vinblastine, and dacarbazine and radiation therapy

Management of cardiac disease in cancer patients throughout oncological treatment: ESMO consensus recommendations

Onkológiai betegek szoros képalkotó követése – előny vagy hátrány?

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