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• W2084578990 abstract "Purpose: TBI is an important part of many hematopoietic stem cell transplant (HSCT) conditioning regimens. Dose escalation of TBI has been difficult due to associated organ toxicities. A method to deliver a more targeted dose of TBI to sites of greatest tumor burden is needed to reduce dose to normal organs, reduce toxicities, and permit dose escalation. The purpose of this study was to evaluate the delivery of targeted myeloablative doses of radiation to bone and marrow using a recently developed image guided tomographic intensity modulated radiation therapy delivery system (tomotherapy). Methods: CT data sets from 3 patients (2 AML and 1 multiple myeloma) were used for dosimetry planning studies to evaluate two strategies: total marrow irradiation (TMI), where the target region was defined as the skeletal bone, and total marrow and lymphoid irradiation (TMLI), where the target regions were defined as bone, major lymph node chains, liver, spleen, and sanctuary sites, such as brain. Organ doses and dose distributions were compared to conventional TBI. Results: A 1.7 to 7.5-fold reduction in median organ dose was observed with TMI and TMLI compared to conventional TBI. Dose-volume histogram analysis predicted for the potential to escalate dose to bone and marrow up to 20 Gy with TMI, while maintaining doses to normal organs at lower levels compared to conventional TBI to 12 Gy (Table) . Results were similar for the adult and pediatric patients indicating that this method will be applicable to most patients regardless of frame size. TMI to 10 Gy was delivered as part of an autologous tandem transplant regimen to the patient with multiple myeloma. Clinical results confirmed treatment planning predictions. After TMI, the patient experienced the expected blood count nadir, followed by successful engraftment. Grade 2 nausea and grade 1 emesis were seen briefly on day 2 of TMI. Skin erythema, oral mucositis, esophagitis, and enteritis were not observed. Conclusions: This report demonstrates the feasibility to selectively deliver myeloablative doses of radiation to bone and marrow using Tomotherapy. Organ doses were substantially lower than those associated with standard TBI and predict for the potential to significantly reduce associated toxicities, allowing for dose escalation. Ongoing trials will define the maximum TMI/TMLI doses achievable and define the potential advantages and limitations of this new approach for patients undergoing HSCT (Table1).Tabled 1Median Organ Doses (Gy) for TMI 12 and 20 Gy vs Standard TBI 12 Gy in a 20 Year Old Patient with AMLOrganTMI 12 GyTMI 20 GyStandard TBI 12 GyLungs4.36.88.8Esophagus3.95.612.4Liver6.08.712.3Kidneys5.68.712.2Bowel3.55.012.3Bladder7.07.412.4Eyes6.67.011.3Parotids3.94.811.8Oral cavity2.23.011.8Stomach3.15.012.2Ovaries4.36.012.3Breasts6.98.711.5Heart6.26.412.1Thyroid3.74.912.1Brain4.07.912.0Lens1.51.911.3 Open table in a new tab" @default.
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• W2084578990 date "2006-02-01" @default.
• W2084578990 modified "2023-09-24" @default.
• W2084578990 title "Targeted total marrow irradiation using 3D image guided tomographic intensity modulated radiation therapy: An alternative to standard TBI" @default.
• W2084578990 doi "https://doi.org/10.1016/j.bbmt.2005.11.281" @default.
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