Impact of tumor anatomic characteristics on patient radiation dose during transarterial chemoembolization

Abstract

Objective: The aim of the study was to determine the association between anatomic tumor characteristics and the radiation dose in patients with hepatocellular carcinoma undergoing transarterial chemoembolization (TACE). Materials and Methods: A retrospective study was performed over a 42 months period. A total of 51 TACE procedures were included in the study. Information collected included: Gender, BMI, height, weight, cumulative dose area product (KAP), cumulative reference air kerma (RAK), maximum tumor diameter, multinodular tumors, and embolization material. Parametric univariate and simple linear regression analysis were used to determine associations between quantitative variables. Results: A total of 51 procedures in 37 patients, 19 women (51%) and 18 men (49%), with a mean age of 56 years (±17.3 years) and a mean BMI of 24 kg/m2 were included in the study. Overall, patient radiation dose was as follows: Mean KAP of 542.2 Gy* cm2 (±307 Gy* cm2) with a mean RAK of 2930.2 mGy (±1776.5 mGy). Higher patient radiation doses were observed in men (581.6 ± 262.9 Gy* cm2 vs. 497.8 ± 350.5 Gy* cm2) (P = 0.06) and in patients with higher BMIs (KAP: r = 0.37 [P = 0.01]; RAK: r = 0.4 [P = 0.01]). Patients with multinodular disease were found with lower radiation dose according to RAK (1710.7 ± 1118.6 mGy vs. 3227.7 ± 1789.1 mGy, P = 0.03). Furthermore, logistic regression analysis demonstrated that patients with multinodular disease received 10% lower dose, according to RAK, when compared to patients with single tumors (odds ratio 1.001, 95% confidence interval [CI], 1–1.002) (P = 0.02). Conclusion: TACE is an effective method to treat patients with HCC that may be performed within acceptable radiation dose limits. Anatomic tumor characteristics were found to be associated with patient radiation dose. Interestingly, multi-tumor disease was found to cause a radiation dose reduction of 10%.