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Article Dans Une Revue Circulation: Cardiovascular Interventions Année : 2018

Projected Future Cancer Risks in Children Treated With Fluoroscopy-Guided Cardiac Catheterization Procedures

Résumé

Background: Cardiac catheterization procedures (CCPs) are increasingly performed in children with congenital heart diseases who have now a long life expectancy and consequently potential long term radiation-induced risks. We evaluated organ equivalent radiation doses and projected Lifetime Attributable Risks (LARs) of cancer incidence from the most frequent procedures in pediatrics: atrial septal defect (ASD) closure, patent ductus arteriosus (PDA) occlusion or pulmonary valvuloplasty. Methods: Organ equivalent doses were individually estimated for 1251 procedures performed in children aged ≤15 years at two reference catheterization centers in France in 2009-2013, based on medical records and exposure scenarios. Gender-specific LARs were projected using the RadRAT software which incorporates extended BEIR VII risk models, various sources of risk projection uncertainties and dose variability. Survival probabilities and baseline cancer risks were those of lifelong non-smokers with no reduced life expectancy due to congenital cardiac diseases. Results: Median equivalent doses were 1-4 mSv (ASD closure), 8-17 mSv (PDA occlusion), and 10 mSv (pulmonary valvuloplasty) to both the lungs and breasts depending on patient age, and ≤10 mSv to other organs. There was a large individual variability, even for a given CCP type and patient age group. Median LARs ranged between 0.3 and 1.4 (ASD closure), 0.6 and 5.0 (PDA occlusion), and 1.0 and 12.0 (pulmonary valvuloplasty) per 1000 procedures, depending on patient gender and age at treatment. These excess risks from CCP radiation exposure would represent 0.4% to 6.0% of children’ total lifetime cancer risk. For the 10% of procedures (all types combined) with highest exposures, LARs reached 4.2 per 1000 [95% Uncertainty Interval (UI): 0.8-13.1] in boys and 22.2 per 1000 (95%UI: 7.4-45.6) in girls. In boys, lung cancer accounted for 70-80% of the projected LARs whereas in girls it accounted for 20-60% and breast cancer for 30-80% of the excess risks, depending on the CCP type and patient age. Conclusion: There was a large individual variability in radiation exposure which may lead to substantial organ equivalent doses and increased cancer risks in some cases. This suggests the need for dose reporting in clinical practice to support recommendations for long term surveillance and prevention strategies.
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hal-02900978 , version 1 (22-07-2020)

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Citer

N. Journy, Serge Dreuil, E. Rage, François de Zordo-Banliat, Damien Bonnet, et al.. Projected Future Cancer Risks in Children Treated With Fluoroscopy-Guided Cardiac Catheterization Procedures. Circulation: Cardiovascular Interventions, 2018, 11 (11), pp.e006765. ⟨10.1161/CIRCINTERVENTIONS.118.006765⟩. ⟨hal-02900978⟩
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