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Modern Total Body Irradiation (TBI): Intensity-Modulated Radiation Treatment (IMRT)

  • Savita V. DandapaniEmail author
  • Jeffrey Y. C. WongEmail author
Chapter
  • 31 Downloads

Abstract

Total body irradiation (TBI) is used as part of the conditioning regimen for allogeneic stem cell transplants since the 1970s. Current TBI uses 2D radiation planning to treat the whole body with lung blocks. Currently, lung is the only normal organ that is spared in full dose TBI, but we only have an estimate of the lung dose due to 2D planning. Recent papers suggest that TBI toxicity could be lowered by sparing normal organs the TBI dose and providing specific guidelines for lung dose. Intensity-modulated radiation treatment (IMRT) is a conformal, more targeted form of radiation that treats patients with 3D planning. With IMRT TBI, we can selectively prescribe full dose TBI while sparing critical organs such as lungs, kidney, and lens. Moreover, IMRT TBI allows more accurate dosimetric calculations of dose to normal structures. With modern technology and widespread use of IMRT already, we expect IMRT TBI to become the new standard for TBI.

References

  1. 1.
    Wong JYC, et al. Total body irradiation: guidelines from the international lymphoma radiation oncology group (ILROG). Int J Radiat Oncol Biol Phys. 2018;101(3):521–9.CrossRefGoogle Scholar
  2. 2.
    Paix A, et al. Total body irradiation in allogeneic bone marrow transplantation conditioning regimens: a review. Crit Rev Oncol Hematol. 2018;123:138–48.CrossRefGoogle Scholar
  3. 3.
    Deeg HJ. Acute and delayed toxicities of total body irradiation. Seattle marrow transplant team. Int J Radiat Oncol Biol Phys. 1983;9(12):1933–9.CrossRefGoogle Scholar
  4. 4.
    Springer A, et al. Total body irradiation with volumetric modulated arc therapy: Dosimetric data and first clinical experience. Radiat Oncol. 2016;11:46.CrossRefGoogle Scholar
  5. 5.
    Tas B, et al. Total-body irradiation using linac-based volumetric modulated arc therapy: its clinical accuracy, feasibility and reliability. Radiother Oncol. 2018;129(3):527–33.CrossRefGoogle Scholar
  6. 6.
    Sampath S, Schultheiss TE, Wong J. Dose response and factors related to interstitial pneumonitis after bone marrow transplant. Int J Radiat Oncol Biol Phys. 2005;63(3):876–84.CrossRefGoogle Scholar
  7. 7.
    Cheng JC, Schultheiss TE, Wong JY. Impact of drug therapy, radiation dose, and dose rate on renal toxicity following bone marrow transplantation. Int J Radiat Oncol Biol Phys. 2008;71(5):1436–43.CrossRefGoogle Scholar
  8. 8.
    Hall MD, et al. Dose response for radiation cataractogenesis: a meta-regression of hematopoietic stem cell transplantation regimens. Int J Radiat Oncol Biol Phys. 2015;91(1):22–9.CrossRefGoogle Scholar
  9. 9.
    Ahmed S, et al. Translating bed total body irradiation lung shielding and dose optimization using asymmetric MLC apertures. J Appl Clin Med Phys. 2016;17(2):112–22.CrossRefGoogle Scholar
  10. 10.
    Baker KS, et al. Total body irradiation dose and risk of subsequent neoplasms following allogeneic hematopoietic cell transplantation. Blood. 2019;133(26):2790–9.CrossRefGoogle Scholar
  11. 11.
    Schultheiss TE, et al. Image-guided total marrow and total lymphatic irradiation using helical tomotherapy. Int J Radiat Oncol Biol Phys. 2007;67(4):1259–67.CrossRefGoogle Scholar
  12. 12.
    Somlo G, et al. Total marrow irradiation: a new ablative regimen as part of tandem autologous stem cell transplantation for patients with multiple myeloma. Clin Cancer Res. 2011;17(1):174–82.CrossRefGoogle Scholar
  13. 13.
    Stein A, et al. Phase I trial of total marrow and lymphoid irradiation transplantation conditioning in patients with relapsed/refractory acute leukemia. Biol Blood Marrow Transplant. 2017;23(4):618–24.CrossRefGoogle Scholar
  14. 14.
    Wong JY, et al. Targeted total marrow irradiation using three-dimensional image-guided tomographic intensity-modulated radiation therapy: an alternative to standard total body irradiation. Biol Blood Marrow Transplant. 2006;12(3):306–15.CrossRefGoogle Scholar
  15. 15.
    Wong JY, et al. Image-guided total-marrow irradiation using helical tomotherapy in patients with multiple myeloma and acute leukemia undergoing hematopoietic cell transplantation. Int J Radiat Oncol Biol Phys. 2009;73(1):273–9.CrossRefGoogle Scholar
  16. 16.
    Kim JH, et al. Extramedullary relapse following total marrow and lymphoid irradiation in patients undergoing allogeneic hematopoietic cell transplantation. Int J Radiat Oncol Biol Phys. 2014;89(1):75–81.CrossRefGoogle Scholar
  17. 17.
    Wong JY, et al. Dose escalation of total marrow irradiation with concurrent chemotherapy in patients with advanced acute leukemia undergoing allogeneic hematopoietic cell transplantation. Int J Radiat Oncol Biol Phys. 2013;85(1):148–56.CrossRefGoogle Scholar
  18. 18.
    Kelsey CR, et al. Severe pulmonary toxicity after myeloablative conditioning using total body irradiation: an assessment of risk factors. Int J Radiat Oncol Biol Phys. 2011;81(3):812–8.CrossRefGoogle Scholar
  19. 19.
    Abugideiri M, et al. Factors influencing pulmonary toxicity in children undergoing allogeneic hematopoietic stem cell transplantation in the setting of total body irradiation-based myeloablative conditioning. Int J Radiat Oncol Biol Phys. 2016;94(2):349–59.CrossRefGoogle Scholar
  20. 20.
    Esiashvili N, et al. Association of higher lung dose received during total body irradiation for allogeneic hematopoetic stem cell transplantation in children with acute lymphoblastic leukemia with inferior progression-free and overall survival: a report from the Children’s oncology group. J Clin Oncol. 2015;33:10030.CrossRefGoogle Scholar
  21. 21.
    Zhuang AH, et al. Dosimetric study and verification of total body irradiation using helical tomotherapy and its comparison to extended SSD technique. Med Dosim. 2010;35(4):243–9.CrossRefGoogle Scholar
  22. 22.
    Gruen A, et al. Total body irradiation (TBI) using helical Tomotherapy in children and young adults undergoing stem cell transplantation. Radiat Oncol. 2013;8:92.CrossRefGoogle Scholar
  23. 23.
    Sarradin V, et al. Total body irradiation using helical Tomotherapy. Cancer Radiother. 2018;22(1):17–24.CrossRefGoogle Scholar
  24. 24.
    Sullivan KM, et al. Myeloablative autologous stem-cell transplantation for severe scleroderma. N Engl J Med. 2018;378(1):35–47.CrossRefGoogle Scholar
  25. 25.
    Han C, Schultheisss TE, Wong JY. Dosimetric study of volumetric modulated arc therapy fields for total marrow irradiation. Radiother Oncol. 2012;102(2):315–20.CrossRefGoogle Scholar
  26. 26.
    Aydogan B, Mundt AJ, Roeske JC. Linac-based intensity modulated total marrow irradiation (IM-TMI). Technol Cancer Res Treat. 2006;5(5):513–9.CrossRefGoogle Scholar
  27. 27.
    Aydogan B, et al. Total marrow irradiation with RapidArc volumetric arc therapy. Int J Radiat Oncol Biol Phys. 2011;81(2):592–9.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  1. 1.Department of Radiation OncologyCity of HopeDuarteUSA

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