Introduction:Percutaneous cryoablation (PCA) can be a valid alternative to partial nephrectomy for patients with cT1a renal tumors. A potential disadvantage of PCA is radiation exposure for patients, though the exact significance of this is unknown. This study aims to uncover the degree of radiation exposure during PCA and what factors are of influence.Methods:This is a retrospective analysis of a prospectively maintained database of patients who underwent CT-guided PCA for cT1 renal cell carcinoma (RCC) between January 2014 and September 2024. The median effective dose (mSV) of PCA was calculated and compared to the expected cumulative radiation exposure during follow-up. Multivariate linear regression was performed to identify factors predictive of higher radiation exposure (mSV).Results: A total of 164 PCAs were performed, with radiation data available for 133 cases. Mean age was 65 (±11) years and the mean tumor diameter was 28 (±9.6) mm. Median effective dose of the CA procedures was 26 mSV (IQR 18–37). The estimated cumulative effective dose of follow-up CT scans according to 2016 and 2024 European Association of Urology guidelines was 158 (IQR 117–213) and 105 mSV (IQR 78–142), respectively. Multivariate linear regression analysis identified BMI (OR 1.723,p< 0.001), the number of needles used (OR 4.060,p< 0.001), and the necessity for additional procedures (OR 8.056,p< 0.001) as significant predictors of a higher effective dose.Conclusions:We found a median effective dose of 26 mSV for PCA, which is relatively low compared to the cumulative radiation exposure associated with CT scans during follow-up of patients post-ablation according to the guidelines. Furthermore, increased BMI, a higher number of required needles and the execution of additional procedures are all associated with a higher effective dose.
引言：对于cT1a期肾肿瘤患者，经皮冷冻消融术（PCA）可作为肾部分切除术的有效替代方案。PCA的一个潜在劣势是患者会接受辐射暴露，但其确切影响尚不明确。本研究旨在揭示PCA过程中的辐射暴露程度及其影响因素。 方法：本研究对2014年1月至2024年9月期间接受CT引导下PCA治疗的cT1期肾细胞癌（RCC）患者前瞻性数据库进行回顾性分析。计算PCA的中位有效剂量（mSV），并与随访期间预期累积辐射暴露量进行比较。通过多元线性回归分析确定预测较高辐射暴露（mSV）的影响因素。 结果：共实施164例PCA手术，其中133例具有完整的辐射数据。患者平均年龄为65（±11）岁，肿瘤平均直径为28（±9.6）毫米。冷冻消融手术的中位有效剂量为26 mSV（四分位距18-37）。根据2016年和2024年欧洲泌尿外科协会指南，随访期间CT扫描的预估累积有效剂量分别为158 mSV（四分位距117-213）和105 mSV（四分位距78-142）。多元线性回归分析显示，体重指数（比值比1.723，p<0.001）、使用穿刺针数量（比值比4.060，p<0.001）以及是否需要附加操作（比值比8.056，p<0.001）是预测较高有效剂量的显著影响因素。 结论：本研究发现PCA的中位有效剂量为26 mSV，相较于指南推荐的消融术后患者随访期间CT扫描相关累积辐射暴露量，该数值相对较低。此外，较高的体重指数、更多穿刺针的使用以及附加操作的实施均与较高的有效剂量相关。
A Closer Look at Radiation Exposure During Percutaneous Cryoablation for T1 Renal Tumors
肿瘤(癌症)患者之家