1
|
Kutaiba N, Varcoe JG, Barnes P, Succar N, Lau E, Patwala K, Low E, Ardalan Z, Gow P, Goodwin M. Radiation exposure from radiological procedures in liver transplant candidates with hepatocellular carcinoma. Eur J Radiol 2023; 158:110656. [PMID: 36542933 DOI: 10.1016/j.ejrad.2022.110656] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 10/25/2022] [Accepted: 12/13/2022] [Indexed: 12/23/2022]
Abstract
PURPOSE Candidates for liver transplantation (LT) with hepatocellular carcinoma (HCC) undergo a large number of diagnostic and interventional radiology procedures. A significant proportion of such procedures involve ionizing radiation with increased lifetime risk of cancer. The objective of our study was to review LT candidates with HCC to quantify ionizing radiation doses from different radiology procedures performed at a single transplant center. METHOD We retrospectively reviewed 179 adult patients with HCC (median age 58.6 years [IQR, 55-62]; 155 [86.6%] males) who were accepted for LT between April 2010 and Dec 2018. Radiology procedures and radiation doses were retrieved and the total and median radiation effective dose in millisieverts (mSv) were calculated for different procedures. Exposure to ionizing radiation was categorized based on previously reported thresholds. RESULTS We assessed 9,986 radiology procedures for our cohort. Patients had a median effective dose prior to transplantation of 254 mSv (IQR, 130-421) with an annualized rate of 152 mSv (IQR, 92-266). Patient median dose increased to 316 mSv (IQR, 159-478) when including exposures post-LT within the study period. 85% of overall exposure was in the extremely high exposure category (>100 mSv). Interventional procedures represented 13% of procedures with substantial radiation and contributed to 45% of radiation exposure while abdominal CTs represented 39% of total procedures and contributed to 45% of radiation exposure. CONCLUSIONS Patients with HCC considered for LT undergo radiology procedures with significant cumulative radiation exposure. Attempts to reduce radiation exposure are suggested by minimizing unnecessary procedures and utilizing ones without ionizing radiation. Improving interventional techniques to reduce radiation doses is needed without compromising treatment delivery.
Collapse
Affiliation(s)
- Numan Kutaiba
- Radiology Department, Austin Health, Melbourne, Victoria, Australia; The University of Melbourne, Victoria, Australia.
| | - Joshua G Varcoe
- Australian Radiation Protection and Nuclear Safety Agency, Melbourne, Victoria, Australia; Medical Physics, Austin Health, Melbourne, Victoria, Australia
| | - Peter Barnes
- Medical Physics, Austin Health, Melbourne, Victoria, Australia
| | - Natalie Succar
- Radiology Department, Austin Health, Melbourne, Victoria, Australia
| | - Eddie Lau
- Radiology Department, Austin Health, Melbourne, Victoria, Australia; The University of Melbourne, Victoria, Australia; Molecular Imaging and Therapy, Austin Health, Melbourne, Victoria, Australia
| | - Kurvi Patwala
- Liver Transplant Unit, Austin Health, Melbourne, Victoria, Australia
| | - Elizabeth Low
- Liver Transplant Unit, Austin Health, Melbourne, Victoria, Australia
| | - Zaid Ardalan
- Department of Gastroenterology, Alfred Health and Monash University, Melbourne, Victoria, Australia
| | - Paul Gow
- The University of Melbourne, Victoria, Australia; Liver Transplant Unit, Austin Health, Melbourne, Victoria, Australia
| | - Mark Goodwin
- Radiology Department, Austin Health, Melbourne, Victoria, Australia; The University of Melbourne, Victoria, Australia
| |
Collapse
|
2
|
Yuan X, Zhuang M, Zhu X, Cheng D, Liu J, Sun D, Qiu X, Lu Y, Sartorius K. Emerging Perspectives of Bone Metastasis in Hepatocellular Carcinoma. Front Oncol 2022; 12:943866. [PMID: 35847843 PMCID: PMC9277479 DOI: 10.3389/fonc.2022.943866] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Accepted: 05/30/2022] [Indexed: 12/09/2022] Open
Abstract
Recent evidence suggests the global incidence and mortality of hepatocellular carcinoma (HCC) are increasing. Although the highest incidence of HCC remains entrenched in WHO regions with high levels of HBV-HCV infection, the etiology of this disease is rapidly changing to include other lifestyle risk factors. Extrahepatic metastasis is a frequent feature of advanced HCC and most commonly locates in the lungs and bone. Bone metastasis in HCC (HCC-BM) signals a more aggressive stage of disease and a poorer prognosis, simultaneously HCC-BM compromises the function and integrity of bone tissue. HCC induced osteolysis is a prominent feature of metastasis that complicates treatment needed for pathologic fractures, bone pain and other skeletal events like hypercalcemia and nerve compression. Early detection of bone metastases facilitates the treatment strategy for avoiding and relieving complications. Although recent therapeutic advances in HCC like targeting agents and immunotherapy have improved survival, the prognosis for patients with HCC-BM remains problematic. The identification of critical HCC-BM pathways in the bone microenvironment could provide important insights to guide future detection and therapy. This review presents an overview of the clinical development of bone metastases in HCC, identifying key clinical features and identifying potential molecular targets that can be deployed as diagnostic tools or therapeutic agents.
Collapse
Affiliation(s)
- Xiaofeng Yuan
- The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Ming Zhuang
- The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Xi Zhu
- The Third Affiliated Hospital of Soochow University, Changzhou, China
- Department of Infectious Diseases, The First Peoples’ Hospital of Kunshan, Kunshan, China
| | - Dong Cheng
- The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Jie Liu
- The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Donglin Sun
- The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Xubin Qiu
- The Third Affiliated Hospital of Soochow University, Changzhou, China
- *Correspondence: Xubin Qiu, ; Yunjie Lu, ; Kurt Sartorius,
| | - Yunjie Lu
- The Third Affiliated Hospital of Soochow University, Changzhou, China
- *Correspondence: Xubin Qiu, ; Yunjie Lu, ; Kurt Sartorius,
| | - Kurt Sartorius
- Hepatitis Diversity Research Unit, School of Internal Medicine, University of the Witwatersrand, Johannesburg, South Africa
- Africa Hepatopancreatobiliary Cancer Consortium (AHPBCC), Mayo Clinic, Jacksonville, FL, United States
- School of Laboratory Medicine and Molecular Sciences, College of Health Science, University of KwaZulu-Natal, Durban, South Africa
- *Correspondence: Xubin Qiu, ; Yunjie Lu, ; Kurt Sartorius,
| |
Collapse
|