Total body irradiation in Australia and New Zealand: results of a practice survey

Fog, L.S.; Wirth, Andrew; MacManus, Michael; Downes, Simon; Grace, M; Moggré, Alicia; Mugabe, Koki; Neveri, Gabor; Nourbehesht, Lisa; Panettieri, Vanessa; Pope, Dane; Sim, Lucy; Stanton, Cameron; Steer, B; Stewart, Allan; Ungureanu, E; Kron, Tomas

doi:10.1007/s13246-020-00878-z

Cited by 14 publications

(19 citation statements)

References 16 publications

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“…Studinski et al (2017) showed that for TBI no commonly accepted planning and treatment delivery exists. Similar findings have been published recently in Japanese (Ishibashi et al 2017(Ishibashi et al , 2018, European-Middle East (Giebel et al 2014), Australian (Nelligan et al 2015, Fog et al 2020 and American studies (Holmes et al 2009, Das et al 2018. TSI is much less performed clinically but, again, multiple approaches exist in treatment techniques (Piotrowski et al 2013).…”

supporting

confidence: 80%

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Total Body Irradiation and Total Skin Irradiation Techniques in Belgium and the Netherlands: Current Clinical Practice

Koken

Murrer

2021

Advances in Radiation Oncology

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This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

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supporting

confidence: 80%

“… 7 Similar findings have been published recently in Japanese, European-Middle East, Australian, and American studies. 8 , 9 , 10 , 11 , 12 , 13 , 14 TSI is much less performed clinically but, again, multiple approaches exist in treatment techniques. 15 …”

Section: Introductionmentioning

confidence: 99%

Total Body Irradiation and Total Skin Irradiation Techniques in Belgium and the Netherlands: Current Clinical Practice

Koken

Murrer

2021

Advances in Radiation Oncology

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“…In adults, a European survey among 56 centers in 23 countries reported important heterogeneity of TBI techniques [37]. Another recent survey in Australia and New Zealand reported use of mainly fractionated TBI, but heterogeneity in shielding and TBI procedures [38]. Guidelines published by Wong et al in 2018 gave directions to homogenize indications and procedures for TBI in adults [35].…”

Section: Discussionmentioning

confidence: 99%

Towards homogenization of total body irradiation practices in pediatric patients across SIOPE affiliated centers. A survey by the SIOPE radiation oncology working group

Hoeben

Pazos

Albert³

et al. 2021

Radiotherapy and Oncology

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Background and purpose: To reduce relapse risk, Total Body Irradiation (TBI) is part of conditioning regimens for hematopoietic stem cell transplantation (HSCT) in pediatric acute leukemia. The study purpose was to evaluate clinical practices regarding TBI, such as fractionation, organ shielding and delivery techniques, among SIOPE affiliated radiotherapy centers. Methods: An electronic survey was sent out to 233 SIOPE affiliated centers, containing 57 questions about clinical practice of TBI. Surveys could be answered anonymously. Results: From over 25 countries, 82 responses were collected. For TBI-performing centers, 40/48 irradiated 10 pediatric patients annually (range: 1-2 to >25). Most indications concerned acute lymphoblastic leukemia (ALL) or acute myeloid leukemia (AML). Four different fractionation schedules were used, of which 12 Gy in 6 fractions was applied in 91% for ALL and 86% for AML. Dose reduction to the lungs, mostly to a mean dose of 8-10 Gy, was applied by 28/33 centers for ALL and 19/21 centers for AML, in contrast to much less applied dose reduction to the kidneys (7/33 ALL and 7/21 AML), thyroid (2/33 ALL and 2/21 AML), liver (4/33 ALL and 3/21 AML) and lenses (4/33 ALL and 4/21 AML). Conventional TBI techniques were used by 24/29 responding centers, while 5/29 used advanced optimized planning techniques. Conclusion: Across SIOPE, there is a high level of uniformity in fractionation and use of lung shielding. Practices vary regarding other organs-at-risk shielding and implementation of advanced techniques. A SIOPE radiotherapy working group will be established to define international guidelines for pediatric TBI.

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“…The Use of a Treatment Planning System Several clinics deliver TBI plans calculated without the use of a treatment planning system (TPS) (25). These non-TPS based techniques may have remained unchanged for decades and do not allow for the determination of dose-volume histograms of the body or the OAR to be evaluated the way they would be in mainstream radiotherapy practise.…”

Section: Extended Ssd Treatmentsmentioning

confidence: 99%

“…Gradually, studies showed decreased toxicities and equal or improved survival with fractionated TBI (22)(23)(24), and this has become the standard. However, institutions have developed site-specific TBI setups and techniques, making practises heterogeneous (25)(26)(27)(28). With technological advances, general radiation treatments have evolved into highly conformal intensity-modulated techniques delivering high doses to treatment volumes while increasingly sparing the surrounding tissues.…”

Section: Introductionmentioning

confidence: 99%

Total Body Irradiation in Haematopoietic Stem Cell Transplantation for Paediatric Acute Lymphoblastic Leukaemia: Review of the Literature and Future Directions

et al. 2021

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Total body irradiation (TBI) has been a pivotal component of the conditioning regimen for allogeneic myeloablative haematopoietic stem cell transplantation (HSCT) in very-high-risk acute lymphoblastic leukaemia (ALL) for decades, especially in children and young adults. The myeloablative conditioning regimen has two aims: (1) to eradicate leukaemic cells, and (2) to prevent rejection of the graft through suppression of the recipient's immune system. Radiotherapy has the advantage of achieving an adequate dose effect in sanctuary sites and in areas with poor blood supply. However, radiotherapy is subject to radiobiological trade-offs between ALL cell destruction, immune and haematopoietic stem cell survival, and various adverse effects in normal tissue. To diminish toxicity, a shift from single-fraction to fractionated TBI has taken place. However, HSCT and TBI are still associated with multiple late sequelae, leaving room for improvement. This review discusses the past developments of TBI and considerations for dose, fractionation and dose-rate, as well as issues regarding TBI setup performance, limitations and possibilities for improvement. TBI is typically delivered using conventional irradiation techniques and centres have locally developed heterogeneous treatment methods and ways to achieve reduced doses in several organs. There are, however, limitations in options to shield organs at risk without compromising the anti-leukaemic and immunosuppressive effects of conventional TBI. Technological improvements in radiotherapy planning and delivery with highly conformal TBI or total marrow irradiation (TMI), and total marrow and lymphoid irradiation (TMLI) have opened the way to investigate the potential reduction of radiotherapy-related toxicities without jeopardising efficacy. The demonstration of the superiority of TBI compared with chemotherapy-only conditioning regimens for event-free and overall survival in the randomised For Omitting Radiation Under Majority age (FORUM) trial in children with high-risk ALL makes exploration of the optimal use of TBI delivery mandatory. Standardisation and comprehensive reporting of conventional TBI techniques as well as cooperation between radiotherapy centres may help to increase the ratio between treatment outcomes and toxicity, and future studies must determine potential added benefit of innovative conformal techniques to ultimately improve quality of life for paediatric ALL patients receiving TBI-conditioned HSCT.

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Total body irradiation in Australia and New Zealand: results of a practice survey

Cited by 14 publications

References 16 publications

Total Body Irradiation and Total Skin Irradiation Techniques in Belgium and the Netherlands: Current Clinical Practice

Total Body Irradiation and Total Skin Irradiation Techniques in Belgium and the Netherlands: Current Clinical Practice

Towards homogenization of total body irradiation practices in pediatric patients across SIOPE affiliated centers. A survey by the SIOPE radiation oncology working group

Total Body Irradiation in Haematopoietic Stem Cell Transplantation for Paediatric Acute Lymphoblastic Leukaemia: Review of the Literature and Future Directions

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