“…Nine papers were found with results of one specific TBI scheme [1,3,10,14,18,21,30,33,41] (Table 1). Several studies could not be included because of obscurity of dose rate or number of fractions, abundance of autologous-transplanted patients, or because of a too short follow-up period [6, 13, 15-17, 35, 37, 38, 43].…”
“…Nine papers were found with results of one specific TBI scheme [1,3,10,14,18,21,30,33,41] (Table 1). Several studies could not be included because of obscurity of dose rate or number of fractions, abundance of autologous-transplanted patients, or because of a too short follow-up period [6, 13, 15-17, 35, 37, 38, 43].…”
“…RT is delivered to bone marrow prior to hematopoietic stem cell transplantation (HSCT) as part of a conditioning regimen that provides immunosuppression and hematologic malignancy control (Hui et al 2017b). A variety of reported treatment regimens deliver total-body irradiation (TBI) (Deeg et al 1986, Altschuler et al 1990, Clift et al 1990, Gonzalez-Vila et al 1990, Kim et al 1990, Ozsahin et al 1992, Resbeut et al 1995, Long et al 1997, Belkacémi et al 1998, Corvò et al 1999, 2002, Girinsky et al 2000, Bieri et al 2001, Kal et al 2006, total marrow irradiation (TMI), (Hui et al 2005, 2007, Aydogan et al 2006, Wong et al 2006, Schultheiss et al 2007, Wilkie et al 2008, Yeginer et al 2010, Corvo et al 2011 or a combination of both (Hui et al 2017a). While data varies based on the treatment regimen, disease type and progression, transplantation method, and other factors, it has been concluded in several studies that increasing the biologically effective dose to marrow improves disease-free survival after HSCT.…”
Objective. Active bone marrow (ABM) can serve as both an organ at risk and a target in external beam radiotherapy. 18F-fluorothymidine (FLT) PET is the current gold standard for identifying proliferative ABM but it is not approved for human use, and PET scanners are not always available to radiotherapy clinics. Identifying ABM through other, more accessible imaging modalities will allow more patients to receive treatment specific to their ABM distribution. Multi-energy CT (MECT) and fat-fraction MRI (FFMRI) show promise in their ability to characterize bone marrow adiposity, but these methods require validation for identifying proliferative ABM. Approach. Six swine subjects were imaged using FFMRI, fast-kVp switching (FKS) MECT and sequential-scanning (SS) MECT to identify ABM volumes relative to FLT PET-derived ABM volumes. ABM was contoured on FLT PET images as the region within the bone marrow with a SUV above the mean. Bone marrow was then contoured on the FFMRI and MECT images, and thresholds were applied within these contours to determine which threshold produced the best agreement with the FLT PET determined ABM contour. Agreement between contours was measured using the Dice similarity coefficient (DSC). Main results. FFMRI produced the best estimate of the PET ABM contour. Compared to FLT PET ABM volumes, the FFMRI, SS MECT and FKS MECT ABM contours produced average peak DSC of 0.722 ± 0.080, 0.619 ± 0.070, and 0.464 ± 0.080, respectively. The ABM volume was overestimated by 40.51%, 97.63%, and 140.13% by FFMRI, SS MECT and FKS MECT, respectively. Significance. This study explored the ability of FFMRI and MECT to identify the proliferative relative to ABM defined by FLT PET. Of the methods investigated, FFMRI emerged as the most accurate approximation to FLT PET-derived active marrow contour, demonstrating superior performance by both DSC and volume comparison metrics. Both FFMRI and SS MECT show promise for providing patient-specific ABM treatments.
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