BACKGROUND: Total body irradiation (TBI) is widely used for conditioning before hematopoietic cell transplantation. Its efficacy and toxicity may depend on many methodological aspects. The goal of the current study was to explore current clinical practice in this field. METHODS: A questionnaire was sent to all centers collaborating in the European Group for Blood and Marrow Transplantation and included 19 questions regarding various aspects of TBI. A total of 56 centers from 23 countries responded. RESULTS: All centers differed with regard to at least 1 answer. The total maximum dose of TBI used for myeloablative transplantation ranged from 8 grays (Gy) to 14.4 Gy, whereas the dose per fraction was 1.65 Gy to 8 Gy. A total of 16 dose/fractionation modalities were identified. The dose rate ranged from 2.25 centigrays to 37.5 centigrays per minute. The treatment unit was linear accelerator (LINAC) (91%) or cobalt unit (9%). Beams (photons) used for LINAC were reported to range from 6 to 25 megavolts. The most frequent technique used for irradiation was "patient in 1 field," in which 2 fields and 2 patient positions per fraction are used (64%). In 41% of centers, patients were immobilized during TBI. Approximately 93% of centers used in vivo dosimetry with accepted discrepancies between the planned and measured doses of 1.5% to 10%. In 84% of centers, the lungs were shielded during irradiation. The maximum accepted dose for the lungs was 6 Gy to 14.4 Gy. CONCLUSIONS: TBI is an extremely heterogeneous treatment modality. The findings of the current study should warrant caution in the interpretation of clinical studies involving TBI. Further investigation is needed to evaluate how methodological differences influence outcome. Efforts to standardize the method should be considered.
BACKGROUND: Total body irradiation (TBI) is widely used for conditioning before hematopoietic cell transplantation. Its efficacy and toxicity may depend on many methodological aspects. The goal of the current study was to explore current clinical practice in this field. METHODS: A questionnaire was sent to all centers collaborating in the European Group for Blood and Marrow Transplantation and included 19 questions regarding various aspects of TBI. A total of 56 centers from 23 countries responded. RESULTS: All centers differed with regard to at least 1 answer. The total maximum dose of TBI used for myeloablative transplantation ranged from 8 grays (Gy) to 14.4 Gy, whereas the dose per fraction was 1.65 Gy to 8 Gy. A total of 16 dose/fractionation modalities were identified. The dose rate ranged from 2.25 centigrays to 37.5 centigrays per minute. The treatment unit was linear accelerator (LINAC) (91%) or cobalt unit (9%). Beams (photons) used for LINAC were reported to range from 6 to 25 megavolts. The most frequent technique used for irradiation was "patient in 1 field," in which 2 fields and 2 patient positions per fraction are used (64%). In 41% of centers, patients were immobilized during TBI. Approximately 93% of centers used in vivo dosimetry with accepted discrepancies between the planned and measured doses of 1.5% to 10%. In 84% of centers, the lungs were shielded during irradiation. The maximum accepted dose for the lungs was 6 Gy to 14.4 Gy. CONCLUSIONS: TBI is an extremely heterogeneous treatment modality. The findings of the current study should warrant caution in the interpretation of clinical studies involving TBI. Further investigation is needed to evaluate how methodological differences influence outcome. Efforts to standardize the method should be considered.
Authors: Jennifer L Holter-Chakrabarty; Namali Pierson; Mei-Jie Zhang; Xiaochun Zhu; Görgün Akpek; Mahmoud D Aljurf; Andrew S Artz; Frédéric Baron; Christopher N Bredeson; Christopher C Dvorak; Robert B Epstein; Hillard M Lazarus; Richard F Olsson; George B Selby; Kirsten M Williams; Kenneth R Cooke; Marcelo C Pasquini; Philip L McCarthy Journal: Biol Blood Marrow Transplant Date: 2015-03-31 Impact factor: 5.742
Authors: Y S Jethava; S Sica; B Savani; F Socola; M Jagasia; M Mohty; A Nagler; A Bacigalupo Journal: Bone Marrow Transplant Date: 2017-05-15 Impact factor: 5.483
Authors: Mitchell Sabloff; Saurabh Chhabra; Tao Wang; Caitrin Fretham; Natasha Kekre; Allistair Abraham; Kehinde Adekola; Jeffery J Auletta; Christopher Barker; Amer M Beitinjaneh; Christopher Bredeson; Jean-Yves Cahn; Miguel Angel Diaz; Cesar Freytes; Robert Peter Gale; Siddhartha Ganguly; Usama Gergis; Eva Guinan; Betty K Hamilton; Shahrukh Hashmi; Peiman Hematti; Gerhard Hildebrandt; Leona Holmberg; Sanghee Hong; Hillard M Lazarus; Rodrigo Martino; Lori Muffly; Taiga Nishihori; Miguel-Angel Perales; Jean Yared; Shin Mineishi; Edward A Stadtmauer; Marcelo C Pasquini; Alison W Loren Journal: Biol Blood Marrow Transplant Date: 2019-08-29 Impact factor: 5.742
Authors: H Nakasone; T Fukuda; J Kanda; T Mori; S Yano; T Kobayashi; K Miyamura; T Eto; H Kanamori; K Iwato; N Uchida; S Mori; T Nagamura-Inoue; T Ichinohe; Y Atsuta; T Teshima; M Murata Journal: Bone Marrow Transplant Date: 2014-12-22 Impact factor: 5.483
Authors: Petra M Härtl; Marius Treutwein; Matthias G Hautmann; Manuel März; Fabian Pohl; Oliver Kölbl; Barbara Dobler Journal: Radiat Oncol Date: 2016-06-10 Impact factor: 3.481