Bianca A W Hoeben1, Montserrat Pazos2, Michael H Albert3, Enrica Seravalli4, Mirjam E Bosman4, Christoph Losert2, Tom Boterberg5, Farkhad Manapov2, Inna Ospovat6, Soraya Mico Milla7, Candan Demiroz Abakay8, Jacob Engellau9, Gregor Kos10, Stéphane Supiot11, Marc Bierings12, Geert O Janssens13. 1. Dept. of Radiation Oncology, University Medical Center Utrecht, The Netherlands; Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands. Electronic address: b.a.w.hoeben@umcutrecht.nl. 2. Dept. of Radiation Oncology, University Hospital, LMU Munich, Germany. 3. Dept. of Pediatrics, Dr. von Hauner Childrens Hospital, University Hospital, LMU Munich, Germany. 4. Dept. of Radiation Oncology, University Medical Center Utrecht, The Netherlands. 5. Dept. of Radiation Oncology, Ghent University Hospital, Ghent, Belgium. 6. Dept. of Radiation Oncology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel. 7. Dept. of Radiation Oncology, Vall d'Hebron University Hospital, Barcelona, Spain. 8. Dept. of Radiation Oncology, Uludag University Faculty of Medicine Hospital, Bursa, Turkey. 9. Dept. of Radiation Oncology, Skåne University Hospital, Lund, Sweden. 10. Dept. of Radiation Oncology, Institute of Oncology Ljubljana, Slovenia. 11. Dept. of Radiation Oncology, Institut de Cancérologie de l'Ouest, Nantes St. Herblain, France. 12. Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands. 13. Dept. of Radiation Oncology, University Medical Center Utrecht, The Netherlands; Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands.
Abstract
BACKGROUND AND PURPOSE: To reduce relapse risk, Total Body Irradiation (TBI) is part of conditioning regimens for hematopoietic stem cell transplantation (HSCT) in pediatric acute leukemia. The study purpose was to evaluate clinical practices regarding TBI, such as fractionation, organ shielding and delivery techniques, among SIOPE affiliated radiotherapy centers. METHODS: An electronic survey was sent out to 233 SIOPE affiliated centers, containing 57 questions about clinical practice of TBI. Surveys could be answered anonymously. RESULTS: From over 25 countries, 82 responses were collected. For TBI-performing centers, 40/48 irradiated ≤10 pediatric patients annually (range: 1-2 to >25). Most indications concerned acute lymphoblastic leukemia (ALL) or acute myeloid leukemia (AML). Four different fractionation schedules were used, of which 12 Gy in 6 fractions was applied in 91% for ALL and 86% for AML. Dose reduction to the lungs, mostly to a mean dose of 8-10 Gy, was applied by 28/33 centers for ALL and 19/21 centers for AML, in contrast to much less applied dose reduction to the kidneys (7/33 ALL and 7/21 AML), thyroid (2/33 ALL and 2/21 AML), liver (4/33 ALL and 3/21 AML) and lenses (4/33 ALL and 4/21 AML). Conventional TBI techniques were used by 24/29 responding centers, while 5/29 used advanced optimized planning techniques. CONCLUSION: Across SIOPE, there is a high level of uniformity in fractionation and use of lung shielding. Practices vary regarding other organs-at-risk shielding and implementation of advanced techniques. A SIOPE radiotherapy working group will be established to define international guidelines for pediatric TBI.
BACKGROUND AND PURPOSE: To reduce relapse risk, Total Body Irradiation (TBI) is part of conditioning regimens for hematopoietic stem cell transplantation (HSCT) in pediatric acute leukemia. The study purpose was to evaluate clinical practices regarding TBI, such as fractionation, organ shielding and delivery techniques, among SIOPE affiliated radiotherapy centers. METHODS: An electronic survey was sent out to 233 SIOPE affiliated centers, containing 57 questions about clinical practice of TBI. Surveys could be answered anonymously. RESULTS: From over 25 countries, 82 responses were collected. For TBI-performing centers, 40/48 irradiated ≤10 pediatric patients annually (range: 1-2 to >25). Most indications concerned acute lymphoblastic leukemia (ALL) or acute myeloid leukemia (AML). Four different fractionation schedules were used, of which 12 Gy in 6 fractions was applied in 91% for ALL and 86% for AML. Dose reduction to the lungs, mostly to a mean dose of 8-10 Gy, was applied by 28/33 centers for ALL and 19/21 centers for AML, in contrast to much less applied dose reduction to the kidneys (7/33 ALL and 7/21 AML), thyroid (2/33 ALL and 2/21 AML), liver (4/33 ALL and 3/21 AML) and lenses (4/33 ALL and 4/21 AML). Conventional TBI techniques were used by 24/29 responding centers, while 5/29 used advanced optimized planning techniques. CONCLUSION: Across SIOPE, there is a high level of uniformity in fractionation and use of lung shielding. Practices vary regarding other organs-at-risk shielding and implementation of advanced techniques. A SIOPE radiotherapy working group will be established to define international guidelines for pediatric TBI.
Authors: Christina Peters; Michael H Albert; Anna Eichinger; Ulrike Poetschger; Evgenia Glogova; Peter Bader; Oliver Basu; Rita Beier; Birgit Burkhardt; Carl-Friedrich Classen; Alexander Claviez; Selim Corbacioglu; Hedwig E Deubzer; Johann Greil; Bernd Gruhn; Tayfun Güngör; Kinan Kafa; Jörn-Sven Kühl; Peter Lang; Bjoern Soenke Lange; Roland Meisel; Ingo Müller; Martin G Sauer; Paul-Gerhardt Schlegel; Ansgar Schulz; Daniel Stachel; Brigitte Strahm; Angela Wawer Journal: Leukemia Date: 2022-09-12 Impact factor: 12.883
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