Factors Influencing Pulmonary Toxicity in Children Undergoing Allogeneic Hematopoietic Stem Cell Transplantation in the Setting of Total Body Irradiation-Based Myeloablative Conditioning

Abugideiri, Mustafa; Nanda, Ronica H.; Butker, Charlotte; Zhang, Chao; Kim, Sungjin; Chiang, Kuang‐Yueh; Butker, Elizabeth; Khan, Mohammad K.; Haight, Ann E.; Chen, Zhengjia; Esiashvili, Natia

doi:10.1016/j.ijrobp.2015.10.054

Cited by 47 publications

(55 citation statements)

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“…PT is a common and severe complication after allogeneic HSCT following TBI, occurring in 25–80% of patients [ 3 , 6 , 14 , 19 – 23 ]. PT after HSCT can develop from either infectious or non-infectious etiologies.…”

Section: Discussionmentioning

confidence: 99%

“…PT after HSCT can develop from either infectious or non-infectious etiologies. PT accounts for approximately 50% of TRM, [ 3 , 6 , 19 ] and many studies have shown that PT leads to a significant reduction in the overall survival rate [ 3 ]. Therefore, studies on factors affecting the development of PT have been conducted to reduce lung toxicity, which is detrimental to prognosis after TBI followed by HSCT.…”

Section: Discussionmentioning

confidence: 99%

“…A wide variety of TBI doses and fractionation schedules have been studied in different institutions, to decrease toxicities. Among the factors affecting toxicities during TBI and HSCT, the dose rate of TBI is one of the major components for reducing the development of PT [ 3 , 19 , 21 ]. According to the guidelines published by the ACR and the ASTRO, in 2013, many protocols require a dose rate under 20 cGy/min in the setting of twice-daily treatment [ 5 ].…”

Section: Discussionmentioning

confidence: 99%

“…According to the criteria commonly used in previous studies [ 3 , 7 , 8 , 12 ], PT was defined if patients met any one of the following three definitions, after TBI-based HSCT: (1) two of three of the following clinical symptoms: dyspnea/cough or any reference to respiratory symptoms, pyrexia, and hypoxia/ cyanosis; (2) radiographic evidence: chest radiograph with bilateral diffuse shadowing and/or increased density or increased interstitial markings or opacities, or chest computed tomography with diffuse ground glass opacities; or (3) ventilatory defects, as noted on pulmonary function tests with either restrictive patterns or obstructive patterns. The presence of infection was defined by the detection of infectious agents, through media, such as blood culture or bronchoalveolar lavage.…”

Section: Methodsmentioning

confidence: 99%

“…Total body irradiation (TBI)-based myeloablative conditioning, followed by allogeneic stem cell transplantation, is conducted for patients with high-risk or relapsed hematolymphoid malignancies [ 1 – 3 ]. TBI has been used in 46% to 53% of allogeneic hematopoietic stem cell transplantations (HSCT) as a preconditioning component, with other chemotherapeutic agents [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

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Effect of dose rate on pulmonary toxicity in patients with hematolymphoid malignancies undergoing total body irradiation

Kim

Yoon

et al. 2018

Radiat Oncol

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BackgroundThis study evaluated the effect of radiation dose rate in patients with hematolymphoid malignancies undergoing myeloablative conditioning with total body irradiation (TBI), for hematopoietic stem cell transplantation.MethodsThe incidence of pulmonary toxicity (PT) and treatment efficacy were compared between the conventional (≥ 6 cGy/min) and reduced dose rate (< 6 cGy/min). Seventy-seven patients receiving once-daily TBI between 2000 and 2016 were reviewed. We compared the cumulative rate of PT, overall survival (OS), relapse, and transplantation-related mortality (TRM) between conventional (n = 54) and reduced (n = 23) groups. Factors associated with PT were assessed in the presence of competing risks.ResultsThe median follow-up time was 40.7 months, and PT occurred in 50 patients (64.9%). On multivariate analyses, the groups classified by the dose rate (P = 0.010), total dose (P = 0.025), and conditioning regimen (P = 0.029) were significant factors for the development of PT. OS was significantly reduced when PT occurred (P < 0.001). However, the OS, relapse, and TRM were not different between the two groups.ConclusionsIn summary, about two-thirds of the patients undergoing daily TBI experienced PT, which affected OS. Therefore, reducing the dose rate (less than 6 cGy/min) of TBI can decrease the risk of PT, without compromising the treatment efficacy.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Effect of dose rate on pulmonary toxicity in patients with hematolymphoid malignancies undergoing total body irradiation

Kim

Yoon

et al. 2018

Radiat Oncol

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Integration of automation into an existing clinical workflow to improve efficiency and reduce errors in the manual treatment planning process for total body irradiation (TBI)

Thomas

Miller

Rabinovitch

et al. 2020

J Applied Clin Med Phys

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Purpose To identify causes of error, and present the concept of an automated technique that improves efficiency and helps to reduce transcription and manual data entry errors in the treatment planning of total body irradiation (TBI). Methods Analysis of incidents submitted to incident learning system (ILS) was performed to identify potential avenues for improvement by implementation of automation of the manual treatment planning process for total body irradiation (TBI). Following this analysis, it became obvious that while the individual components of the TBI treatment planning process were well implemented, the manual ‘bridging’ of the components (transcribing data, manual data entry etc.) were leading to high potential for error. A C#‐based plug‐in treatment planning script was developed to remove the manual parts of the treatment planning workflow that were contributing to increased risk. Results Here we present an example of the implementation of “Glue” programming, combining treatment planning C# scripts with existing spreadsheet calculation worksheets. Prior to the implementation of automation, 35 incident reports related to the TBI treatment process were submitted to the ILS over a 6‐year period, with an average of 1.4 ± 1.7 reports submitted per quarter. While no incidents reached patients, reports ranged from minor documentation issues to potential for mistreatment if not caught before delivery. Since the implementation of automated treatment planning and documentation, treatment planning time per patient, including documentation, has been reduced; from an average of 45 min pre‐automation to <20 min post‐automation. Conclusions Manual treatment planning techniques may be well validated, but they are time‐intensive and have potential for error. Often the barrier to automating these techniques becomes the time required to “re‐code” existing solutions in unfamiliar computer languages. We present the workflow here as a proof of concept that automation may help to improve clinical efficiency and safety for special procedures.

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Total body irradiation delivered using a dedicated Co‐60 TBI unit: Evaluation of dosimetric uniformity and dose verification

Burmeister,

Bossenberger,

Nalichowski

et al. 2023

J Applied Clin Med Phys

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This work presents the dosimetric characteristics of Total Body Irradiation (TBI) delivered using a dedicated Co‐60 TBI unit. We demonstrate the ability to deliver a uniform dose to the entire patient without the need for a beam spoiler or patient‐specific compensation. Full dose distributions are calculated using an in‐house Monte Carlo treatment planning system, and cumulative dose distributions are created by deforming the dose distributions within two different patient orientations. Sample dose distributions and profiles are provided to illustrate the plan characteristics, and dose and DVH statistics are provided for a heterogeneous cohort of patients. The patient cohort includes adult and pediatric patients with a range of 132–198 cm in length and 16.5–37.5 cm in anterior‐posterior thickness. With the exception of the lungs, a uniform dose of 12 Gy is delivered to the patient with nearly the entire volume receiving a dose within 10% of the prescription dose. Mean lung doses (MLDs) are maintained below the estimated threshold for radiation pneumonitis, with MLDs ranging from 7.3 to 9.3 Gy (estimated equivalent dose in 2 Gy fractions (EQD2) of 6.2‐8.5 Gy). Dose uniformity is demonstrated across five anatomical locations within the patient for which mean doses are all within 3.1% of the prescription dose. In‐vivo dosimetry demonstrates excellent agreement between measured and calculated doses, with 78% of measurements within ±5% of the calculated dose and 99% within ±10%. These results demonstrate a state‐of‐the‐art TBI planning and delivery system using a dedicated TBI unit and hybrid in‐house and commercial planning techniques which provide comprehensive dosimetric data for TBI treatment plans that are accurately verified using in‐vivo dosimetry.

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Factors Influencing Pulmonary Toxicity in Children Undergoing Allogeneic Hematopoietic Stem Cell Transplantation in the Setting of Total Body Irradiation-Based Myeloablative Conditioning

Cited by 47 publications

References 40 publications

Effect of dose rate on pulmonary toxicity in patients with hematolymphoid malignancies undergoing total body irradiation

Effect of dose rate on pulmonary toxicity in patients with hematolymphoid malignancies undergoing total body irradiation

Integration of automation into an existing clinical workflow to improve efficiency and reduce errors in the manual treatment planning process for total body irradiation (TBI)

Total body irradiation delivered using a dedicated Co‐60 TBI unit: Evaluation of dosimetric uniformity and dose verification

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