An Evidence-Based Review of Total Body Irradiation

Peters, Mitchell; Taylor, Beth; Turner, Emma

doi:10.1016/j.jmir.2015.09.007

Cited by 15 publications

(18 citation statements)

References 60 publications

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“…Several publications report on TBI and TMI calculations with emphasis on dose distribution [ 13 , 14 ]. An excellent review on the design and development of dosimetric issues from 1980 to 2014 was published recently [ 15 ]. The authors included a few papers on organ complications and immune deficiency after TBI or TMI and/or stem cell transplantation.…”

Section: Introductionmentioning

confidence: 99%

Total body irradiation with volumetric modulated arc therapy: Dosimetric data and first clinical experience

et al. 2016

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Section: Introductionmentioning

confidence: 99%

Total body irradiation with volumetric modulated arc therapy: Dosimetric data and first clinical experience

et al. 2016

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“…To improve dose homogeneity, and the accuracy of dose calculation, centers have recently started using CT scans and 3D treatment planning systems (TPS) to prepare TBI treatment plans [16] , [17] , [18] , [19] . Instead of using cast lead blocks, the multi-leaf collimator (MLC) in the linac can be used to improve homogeneity, and to reduce dose to risk organs.…”

Section: Introductionmentioning

confidence: 99%

Early clinical experience with a total body irradiation technique using field-in-field beams and on-line image guidance

Leeuwen

Verwegen

Kollenburg

et al. 2020

Physics and Imaging in Radiation Oncology

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Background and purpose: Total body irradiation (TBI) is a treatment used in the conditioning of patients prior to hematopoietic stem cell transplantation. We developed an extended-distance TBI technique using a conventional linac with multi-leaf collimator to deliver a homogeneous dose, and spare critical organs. Materials and methods: Patients were treated either in lateral recumbent or in supine position depending on the dose level. A conventional linac was used with the patient midline at 350 cm from the beam source. A series of beams was prepared manually using a 3D treatment planning system (TPS) aiming to improve dose homogeneity, spare the organs at risk and facilitate accurate patient positioning. An optimized dose calculation model for extended-distance treatments was developed using phantom measurements. During treatment, in-vivo dosimetry was performed using electronic dosimeters, and accurate positioning was verified using a mobile megavoltage imager. We analyzed dose volume histogram parameters for 19 patients, and in-vivo measurements for 46 delivered treatment fractions. Results: Optimization of the dose calculation model for TBI improved dose calculation by 2.1% at the beam axis, and 17% at the field edge. Treatment planning dose objectives and constraints were met for 16 of 19 patients. Results of in-vivo dosimetry were within the set limitations (±10%) with mean deviations of 3.7% posterior of the lungs and 0.6% for the abdomen. Conclusions: We developed a TBI treatment technique using a conventional linac and TPS that can reliably be used in the conditioning regimen of patients prior to stem cell transplantation.

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“…Initially the project team conducted an extensive evidence‐based review of different TBI techniques . The decision was made based on specific criteria, including requirements for 3D planning, the use of lung and kidney compensation and a preference for minimal use of additional bolus.…”

Section: Introductionmentioning

confidence: 99%

Modification of a modulated arc total body irradiation technique: Implementation and first clinical experience for paediatric patients

Pemberton

Brady

Taylor

et al. 2018

J of Medical Radiation Sci

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IntroductionTo implement the modulated arc total body irradiation (MATBI) technique within the existing infrastructure of a radiation oncology department. The technique needed to treat paediatric patients of all ages, some of whom would require general anaesthesia (GA).MethodsThe MATBI technique required minor modifications to be incorporated within existing departmental infrastructure. Ancillary equipment essential to the technique were identified and in some cases custom designed to meet health and safety criteria. GA equipment was also considered. To evaluate the effectiveness of the implemented technique, an audit of the cases clinically treated was conducted.ResultsA motorised treatment couch was designed to allow the patient to be positioned in stabilisation equipment at a height, then lowered to the floor to accommodate source‐to‐skin‐distances from 180 cm to 198 cm to treat the fixed 40 cm × 40 cm field size. Treatment couch design also facilitated positioning of the bespoke two‐part spoiler. While organ at risk dose is limited using a beam weight optimisation technique, the dose is further reduced using compensators placed close to the patient's skin on a 3D printed custom‐made support bridge. A digital radiography system is used to verify compensator position. Fifteen patients have been treated to date for various diseases using a variety of dose fractionations ranging from 2 Gy in a single fraction to 12 Gy in 6 fractions. Five patients have required GA due to age or behavioural issues.ConclusionThe modified MATBI technique and the equipment required for treatment delivery has been found to be well tolerated by all patients.

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An Evidence-Based Review of Total Body Irradiation

Cited by 15 publications

References 60 publications

Total body irradiation with volumetric modulated arc therapy: Dosimetric data and first clinical experience

Total body irradiation with volumetric modulated arc therapy: Dosimetric data and first clinical experience

Early clinical experience with a total body irradiation technique using field-in-field beams and on-line image guidance

Modification of a modulated arc total body irradiation technique: Implementation and first clinical experience for paediatric patients

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