Total marrow irradiation for hematopoietic malignancies using volumetric modulated arc therapy: A review of treatment planning studies

Mancosu, P.; Cozzi, Luca; Muren, L.P.

doi:10.1016/j.phro.2019.08.001

Cited by 22 publications

(20 citation statements)

References 42 publications

(93 reference statements)

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“…TBI 12 and total marrow irradiation, 13 combined or not with chemotherapy, are used for myeloablation and immune suppression before allogeneic or autologous hematopoietic stem cell (HSC) transplantation. The key indications for a TBI-based conditioning regimen are acute lymphoid leukemia followed by acute myeloid leukemia and chronic myeloid leukemia, 12,14,15 and further improvements enhancing tumor control and tolerance are still needed.…”

Section: Introductionmentioning

confidence: 99%

Ultra-high-dose-rate FLASH and Conventional-Dose-Rate Irradiation Differentially Affect Human Acute Lymphoblastic Leukemia and Normal Hematopoiesis

Chabi

Leavitt

et al. 2021

International Journal of Radiation Oncology*Biology*Physics

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Ultra-high-dose-rate FLASH radiation therapy has been shown to minimize side effects of irradiation in various organs while keeping antitumor efficacy. This property, called the FLASH effect, has caused enthusiasm in the radiation oncology community because it opens opportunities for safe dose escalation and improved radiation therapy outcome. Here, we investigated the impact of ultra-high-dose-rate FLASH versus conventional-dose-rate (CONV) total body irradiation (TBI) on humanized models of T-cell acute lymphoblastic leukemia (T-ALL) and normal human hematopoiesis.

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Section: Introductionmentioning

confidence: 99%

Ultra-high-dose-rate FLASH and Conventional-Dose-Rate Irradiation Differentially Affect Human Acute Lymphoblastic Leukemia and Normal Hematopoiesis

Chabi

Leavitt

et al. 2021

International Journal of Radiation Oncology*Biology*Physics

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“…This is possibly the reason why several groups have extensively evaluated it for TBI and TMI/TMLI [8][9][10][11][12][13][14]. Recently VMAT has also been evaluated in this setting to a reasonable success [15,16]. Although we have used HT to treat our patients, the same principles can be broadly applied for VMAT as well.…”

Section: Discussionmentioning

confidence: 99%

Total marrow and lymphoid irradiation with helical tomotherapy: A practical implementation report

Chilukuri

Sundar

Thiyagarajan

et al. 2020

Preprint

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Objective To standardize the technique and resources for total marrow and lymphoid irradiation (TMLI) as part of the conditioning regimen before allogenic bone marrow transplantation (ABMT) using helical tomotherapy.Methods We used this technique in our first 5 patients requiring TMLI. Patients were immobilized using a mask and a whole-body vacuum cushion. CT scanning was performed in head first supine (HFS) and feet first supine (FFS) orientations with an overlap at mid-thigh. Target consisted of the entire skeleton, spleen, sanctuary sites and major lymphatics whereas lungs, kidneys, aero-digestive tract, bowel, parotids, heart and liver were defined as organs at risk (OAR). Treatment was performed in two parts based on 2 different plans generated in HFS and FFS orientations with an overlap at the mid thigh. Patients along with the immobilization device were manually rotated by 180° to change the orientation after the delivery of HFS plan. The dose at the junction was contributed by a complementary dose gradient from each of the plans. Plan was to deliver 95% of 12Gy to 98% of CTV with dose heterogeneity < 10% and pre-specified OAR doe constraints. Megavoltage-CT was used for position verification before each fraction. Patient specific quality assurance and an in-vivo film dosimetry to verify junction dose were performed in all patients.Results Treatment was delivered in two daily fractions of 2Gy each for 3 days with at least 8-hours gap between each fraction. The target coverage goals were met in all the patients. The average person-hours per patient were 16.5, 21.5 and 25.75 for radiation oncologist, radiation therapist and medical physicist respectively. Average in-room time per patient was 9.25 hours with an average beam-on time of 3.32 hours for all the six fractions. Conclusion This report comprehensively describes technique and resource requirements for TMLI and would serve as a practical guide for departments keen to start this service. Despite being time and labor intensive, it can be implemented safely and robustly. We will be using this methodology in a prospective phase II trial to study safety and feasibility of dose escalated TMLI as part of conditioning regimen before ABMT.

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“…The total body and total marrow irradiation techniques (TBI, TMI) are parts of the conditioning regimen required for haematological malignancies before bone marrow transplantation [ 1 – 3 ]. TBI/TMI methods aim to destroy the remaining cancer cells and prevent the patient from rejecting the transplant [ 1 ].…”

Section: Introductionmentioning

confidence: 99%

The impact of different optimization strategies on the agreement between planned and delivered doses during volumetric modulated arc therapy for total marrow irradiation

Piotrowski

Kruszyna-Mochalska

Malicki

2021

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Aim of the study To evaluate the agreement between planned and delivered doses and its potential correlation with the plans’ complexity subjected to dosimetric verification. Material and methods Four isocentre volumetric modulated arc therapy for total marrow irradiation plans optimized simultaneously with (P1) and without (P2) MU reduction were evaluated dosimetrically by γ method performed in a global mode for 4 combinations of γ-index criteria (2%/2 mm, 2%/3 mm, 3%/2 mm, and 3%/3 mm). The evaluation was conducted for 4 regions (head and neck, chest, abdomen and upper pelvis, and lower pelvis and thighs) that were determined geometrically by the isocentres. The Wilcoxon test was used to detect significant differences between γ passing rate (GPR) analysis results for the P1 and P2 plans. The Pearson correlation was used to check the relationship between GPR and the plans’ complexity. Results Except for the head and neck region, the P2 plans had better GPRs than the P1 plans. Only for hard combinations of γ-index criteria (i.e. 2%/3 mm, 2%/2 mm) were the GPRs differences between P1 and P2 clinically meaningful, and they were detected in the chest, abdomen and upper pelvis, and lower pelvis and thighs regions. The highest correlations between GPR and the indices describing the plans’ complexity were found for the chest region. No correlation was found for the head and neck region. Conclusions The P2 plans showed better agreement between planned and delivered doses compared to the P1 plans. The GPR and the plans’ complexity depend on the anatomy region and are most important for the chest region.

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Total marrow irradiation for hematopoietic malignancies using volumetric modulated arc therapy: A review of treatment planning studies

Cited by 22 publications

References 42 publications

Ultra-high-dose-rate FLASH and Conventional-Dose-Rate Irradiation Differentially Affect Human Acute Lymphoblastic Leukemia and Normal Hematopoiesis

Ultra-high-dose-rate FLASH and Conventional-Dose-Rate Irradiation Differentially Affect Human Acute Lymphoblastic Leukemia and Normal Hematopoiesis

Total marrow and lymphoid irradiation with helical tomotherapy: A practical implementation report

The impact of different optimization strategies on the agreement between planned and delivered doses during volumetric modulated arc therapy for total marrow irradiation

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