Ashwin Shinde1, Dongyun Yang2, Paul Frankel2, An Liu1, Chunhui Han1, Bianca Del Vecchio2, Timothy Schultheiss1, Jonathan Cheng1, Richard Li1, Daniel Kim1, Eric H Radany1, Susanta Hui1, George Somlo3, Joseph Rosenthal4, Anthony Stein5, Stephen Forman5, Jeffrey Y C Wong6. 1. Department of Radiation Oncology, City of Hope National Medical Center, Duarte, California. 2. Department of Information Sciences, City of Hope National Medical Center, Duarte, California. 3. Department of Medical Oncology, City of Hope National Medical Center, Duarte, California. 4. Department of Pediatrics, City of Hope National Medical Center, Duarte, California. 5. Department of Hematology and Hematopoietic Transplantation, City of Hope National Medical Center, Duarte, California. 6. Department of Radiation Oncology, City of Hope National Medical Center, Duarte, California. Electronic address: jwong@coh.org.
Abstract
PURPOSE: Toxicities after organ sparing myeloablative total marrow irradiation (TMI) conditioning regimens have not been well characterized. The purpose of this study is to report pulmonary, renal, thyroid, and cataract toxicities from a prospective trial monitoring patients up to 8 years after TMI. METHODS AND MATERIALS: A total of 142 patients with primarily multiple myeloma or acute leukemia undergoing hematopoietic cell transplantation were evaluated. Follow-up included pulmonary function tests, serum creatinine, glomerular filtration rate, thyroid panel, and ophthalmologic examinations performed at 100 days, 6 months, and annually. Median TMI dose was 14 Gy (10-19 Gy) delivered at 1.5 to 2.0 Gy twice per day at a dose-rate of 200 cGy/min. RESULTS: Median age was 52 years (range 9-70). Median follow-up (range) for all patients was 2 years (0-8) and for patients alive at the time of last follow-up (n = 50), 5.5 years (0-8). Mean organ doses in Gy were lung 7.0, kidneys 7.1, thyroid 6.7, and lens 2.8. The crude incidence of radiation pneumonitis (RP) was 1 of 142 (0.7%). The cumulative incidence of infection and RP (I/RP) was 22.7% at 2 years post-TMI. Mean lung dose ≤8 Gy predicted for significantly lower rates of I/RP (2-year cumulative incidence 20.8% vs 31.8%, P = .012). No radiation-induced renal toxicity was noted. Hypothyroidism occurred in 6.0% and cataract formation in 7.0% of patients. CONCLUSIONS: TMI delivered with intensity modulated radiation therapy results in lower organ doses and was associated with fewer toxicities compared with historical cohorts treated with conventional total body irradiation. Keeping the mean lung dose to 8 Gy or less was associated with lower pulmonary complications. Further evaluation in clinical trials of intensity modulated radiation therapy to deliver TMI, total marrow and lymphoid irradiation, and organ sparing conformal total body irradiation is warranted.
PURPOSE:Toxicities after organ sparing myeloablative total marrow irradiation (TMI) conditioning regimens have not been well characterized. The purpose of this study is to report pulmonary, renal, thyroid, and cataract toxicities from a prospective trial monitoring patients up to 8 years after TMI. METHODS AND MATERIALS: A total of 142 patients with primarily multiple myeloma or acute leukemia undergoing hematopoietic cell transplantation were evaluated. Follow-up included pulmonary function tests, serum creatinine, glomerular filtration rate, thyroid panel, and ophthalmologic examinations performed at 100 days, 6 months, and annually. Median TMI dose was 14 Gy (10-19 Gy) delivered at 1.5 to 2.0 Gy twice per day at a dose-rate of 200 cGy/min. RESULTS: Median age was 52 years (range 9-70). Median follow-up (range) for all patients was 2 years (0-8) and for patients alive at the time of last follow-up (n = 50), 5.5 years (0-8). Mean organ doses in Gy were lung 7.0, kidneys 7.1, thyroid 6.7, and lens 2.8. The crude incidence of radiation pneumonitis (RP) was 1 of 142 (0.7%). The cumulative incidence of infection and RP (I/RP) was 22.7% at 2 years post-TMI. Mean lung dose ≤8 Gy predicted for significantly lower rates of I/RP (2-year cumulative incidence 20.8% vs 31.8%, P = .012). No radiation-induced renal toxicity was noted. Hypothyroidism occurred in 6.0% and cataract formation in 7.0% of patients. CONCLUSIONS:TMI delivered with intensity modulated radiation therapy results in lower organ doses and was associated with fewer toxicities compared with historical cohorts treated with conventional total body irradiation. Keeping the mean lung dose to 8 Gy or less was associated with lower pulmonary complications. Further evaluation in clinical trials of intensity modulated radiation therapy to deliver TMI, total marrow and lymphoid irradiation, and organ sparing conformal total body irradiation is warranted.
Authors: Marjan Boerma; Catherine M Davis; Isabel L Jackson; Dörthe Schaue; Jacqueline P Williams Journal: Int J Radiat Biol Date: 2021-07-01 Impact factor: 2.694
Authors: Michael Oertel; Jonas Martel; Jan-Henrik Mikesch; Sergiu Scobioala; Christian Reicherts; Kai Kröger; Georg Lenz; Matthias Stelljes; Hans Theodor Eich Journal: Cancers (Basel) Date: 2021-11-11 Impact factor: 6.639
Authors: Bianca A W Hoeben; Jeffrey Y C Wong; Lotte S Fog; Christoph Losert; Andrea R Filippi; Søren M Bentzen; Adriana Balduzzi; Lena Specht Journal: Front Pediatr Date: 2021-12-03 Impact factor: 3.418
Authors: Michael Oertel; Christopher Kittel; Jonas Martel; Jan-Henrik Mikesch; Marco Glashoerster; Matthias Stelljes; Hans Theodor Eich Journal: Cancers (Basel) Date: 2021-06-12 Impact factor: 6.639