Comparative Analysis of the Risk of Radiation Exposure and Cost of Reduced Imaging Intensity For Surveillance of Early-stage Nonseminomatous Germ Cell Tumors

Objective To evaluate the surveillance recommendations for early-stage testis cancer and the risk of secondary malignancies due to increased radiation exposure. Materials and Methods Using National Comprehensive Cancer Network (NCCN) guidelines 2012 and 2014 for early-stage testicular cancer, the numbers of abdominal and pelvic computed tomography scans (CTAPs) and chest radiographies were calculated, and lifetime attributable risk for secondary malignancy was estimated using Biologic Effects of Ionizing Radiation VII organ-specific model for solid organ malignancy based on the initial age of exposure. Cost was based on the Centers for Medicare and Medicaid Services' cost estimates of CTAP and magnetic resonance imaging (MRI). Results The 2012 NCCN protocol uses a maximum of 17 CTAPs over 6 years, whereas 2014 guidelines suggest a maximum of 13 CTAPs. The radiation dosage in 2014 guidelines is decreased by 25% compared to the 2012 NCCN guidelines. The minimum number of CTAPs under the 2014 NCCN protocol reduced radiation dose by 38% compared to the maximum number, this compared to about 50% decrease from the 2012 NCCN guidelines. The median cost for a single CTAP with contrast is $369.30; median cost for a single MRI with contrast is $772.18. As compared to the 2012 protocol, the 2014 guidelines reduced CTAP cost by approximately 24%-54% for minimum and maximum CTAPs allowed. Conclusion There is low, however nonzero, risk of secondary malignancy for surveillance in stage I testicular cancer. There is also a significant cost difference between protocols as well as between CT and MRI modalities.