Biologically Effective Dose in Total-Body Irradiation and Hematopoietic Stem Cell Transplantation

Kal, Henk B.; Kempen-Harteveld, M. Loes van; Heijenbrok‐Kal, Majanka H.; Struikmans, H.

doi:10.1007/s00066-006-1528-6

Cited by 46 publications

(33 citation statements)

References 41 publications

(81 reference statements)

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“…Nevertheless, it is, to our knowledge, the first report of the clinical feasibility of TBI with HT in an actual clinical setting with limited toxicities, reopening the debate of the potential benefits of TBI dose escalation. 35 …”

Section: Discussionmentioning

confidence: 99%

Clinical feasibility of TBI with helical tomotherapy

Peñagarícano

Chao

Rhee

et al. 2010

Bone Marrow Transplant

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Our purpose was to present the clinical feasibility of TBI with helical tomotherapy (HT) in four patients with AML. Treatment planning, delivery, dose verification and summation, toxicity and patient outcomes for each patient are presented. TBI prescription was set in such a manner that 80% of the clinical target volume received 12 Gy in six fractions, at two fractions per day. Dose reconstruction was carried out by recontouring the regions of interest in the daily pretreatment megavoltage computed tomography of each individual fraction and calculating its corresponding dose. A deformable registration model was used for dose summation of all individual fractions. Differences between planned and delivered doses were calculated. Average planned and delivered doses to the regions of interest differed by up to 2.7%. TBI toxicity was limited to radiotherapy oncology group grade 1 dermatitis in all patients and grade 1 headache in one patient. Two patients are alive with no evidence of disease and no GVHD. Two patients died of GVHD, but there was no evidence of disease at the time of death. We conclude that HT simplifies the process of TBI. Dose verification is possible with HT showing small differences between plan and delivered doses.

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Section: Discussionmentioning

confidence: 99%

Clinical feasibility of TBI with helical tomotherapy

Peñagarícano

Chao

Rhee

et al. 2010

Bone Marrow Transplant

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“…50 To overcome these side effects, a fractionated TBI dose with higher biologically effective leukaemic cell kill may give superior suppression of malignant disease while limiting adverse effects on other tissues. 46,51,52 Data supplied by the acute leukaemia working party (ALWP) of the EBMT confirm the superiority of fractionated TBI for children with ALL in CR2 (n ¼ 525, median dose: 12 Gy, divided into two or more fractions, DFS: 5672%) vs single fraction TBI (n ¼ 245, median dose: 10 Gy, DFS 4473%; P ¼ 0.0008). In the same database, this was not observed for children with AML in CR1.…”

Section: Discussionmentioning

confidence: 88%

“…45 A significant relationship between higher TBI doses and lower relapse incidence and increased OS was recently confirmed by a review of literature comparing various TBI regimens. 46 Conversion of our TBI schedules Gy. Taking into account the calculated BED of different TBI schedules for leukaemic cell kill, the BED of our 2 Â 6 Gy regimen is about 25% higher than the BED of the frequently used 6 Â 2 Gy scheme 46 and 38% higher that the 1 Â 8 Gy scheme.…”

Section: Discussionmentioning

confidence: 99%

“…46 Conversion of our TBI schedules Gy. Taking into account the calculated BED of different TBI schedules for leukaemic cell kill, the BED of our 2 Â 6 Gy regimen is about 25% higher than the BED of the frequently used 6 Â 2 Gy scheme 46 and 38% higher that the 1 Â 8 Gy scheme. In the young children, however, a possible decreased relapse rate, following higher BED-TBI will need to be weighed against the increased susceptibility for neurodevelopmental and endocrinological adverse effects 18,[47][48][49] and secondary cancer.…”

Section: Discussionmentioning

confidence: 99%

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HLA-identical haematopoietic stem cell transplantation for acute leukaemia in children: less relapse with higher biologically effective dose of TBI

Willemze

Geskus

Noordijk

et al. 2007

Bone Marrow Transplant

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To examine relapse, survival and transplant-related complications in relationship to disease-and pre-treatment-related characteristics, we evaluated 132 children, who consecutively received an allogeneic HLA-identical SCT for acute leukaemia in our centre: ALL in first remission (n ¼ 24), ALL in second remission (n ¼ 53) and AML in first remission (n ¼ 55). The source of the stem cells was bone marrow in all but three cases. Most patients (89%) were pre-treated with cyclophosphamide and an age-related dose of TBI. Initially, GVHD prophylaxis consisted of long-course MTX only (n ¼ 24), later shortcourse MTX and CsA (n ¼ 102) was given. All patients were nursed in strictly protective isolation and received total gut decontamination to suppress their potentially pathogenic enteric microflora. The 5-year probability of overall survival was 63, 53 and 74% for ALL1, ALL2 and AML1, respectively (median follow-up: 10.6 years). The overall transplant-related mortality was 6%. The incidence of acute GVHD was 17%; 6% was grades II-IV. A higher total biologically effective TBI dose (BED) resulted in a decreased relapse frequency (P ¼ 0.034) and increased overall survival. AML patients with acute GVHD got no relapse (P ¼ 0.02); this was not the case in ALL patients. Fractionated TBI regimens with higher BED should be evaluated in prospective studies.

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“…With respect to dose rate, however, a high dose rate with relatively low total dose can be better than a large single dose at a low dose rate. Also in TBI, the biologically effective dose is decisive to tumor control as well as early and late toxicities [27].…”

Section: Discussionmentioning

confidence: 99%

20 Years of Experience in Static Intensity-Modulated Total-Body Irradiation and Lung Toxicity

Schneider¹,

Schultze

Jensen³

et al. 2007

Strahlenther Onkol

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Biologically Effective Dose in Total-Body Irradiation and Hematopoietic Stem Cell Transplantation

Abstract: "More dose is better", provided that a TBI setting is used limiting the BEDs of lungs, kidneys, and eye lenses.

Cited by 46 publications

References 41 publications

Clinical feasibility of TBI with helical tomotherapy

Clinical feasibility of TBI with helical tomotherapy

HLA-identical haematopoietic stem cell transplantation for acute leukaemia in children: less relapse with higher biologically effective dose of TBI

20 Years of Experience in Static Intensity-Modulated Total-Body Irradiation and Lung Toxicity

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