Helical tomotherapy targeting total bone marrow – First clinical experience at the University of Minnesota

Song, Hui; Verneris, Michael R.; Higgins, Patrick D.; Gerbi, Bruce J.; Weigel, Brenda; Baker, Scott K.; Fraser, Christopher; Tomblyn, Michael; Dusenbery, Kathryn E.

doi:10.1080/02841860601042449

Cited by 53 publications

(48 citation statements)

References 14 publications

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“…o r g radiation therapy (IMRT) is an alternate method of radiation delivery commonly used in the treatment of solid tumors that allows the prescribed dose to be conformed to the target while sparing adjacent normal organs [18]. An IMRT approach to irradiate bone marrow selectively while sparing other organs (total marrow irradiation, TMI) has been previously described in clinical trials using helical tomotherapy [19][20][21][22][23][24][25], whereas we have previously reported preclinical studies on the feasibility of performing linear acceleratorebased intensity-modulated TMI [26][27][28][29].…”

Section: Introductionmentioning

confidence: 99%

Combination of Linear Accelerator–Based Intensity-Modulated Total Marrow Irradiation and Myeloablative Fludarabine/Busulfan: A Phase I Study

Patel

Aydogan

Koshy

et al. 2014

Biology of Blood and Marrow Transplantation

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Here we examined the addition of intensity-modulated total marrow irradiation (TMI) delivered using a linear accelerator to a myeloablative chemotherapy conditioning regimen before allogeneic hematopoietic stem cell transplantation (HSCT). In this phase I study, we enrolled 14 patients with high-risk hematologic malignancies who received escalating doses of TMI at 3 Gy (n = 3), 6 Gy (n = 3), 9 Gy (n = 6), and 12 Gy (n = 2) in combination with intravenous (i.v.) fludarabine 160 mg/m(2) and targeted busulfan (area under the curve, 4800 μM*minute). Peripheral blood mobilized stem cells were obtained from HLA-matched related (n = 9) or unrelated (n = 4) or 1 antigen-mismatched unrelated (n = 1) donors. All patients rapidly engrafted and recovered their immune cells. Overall, Bearman extrahematologic toxicity were limited to grades 1 or 2, with oral mucositis grade 1 in 64% and grade 2 in 36% of the patients. With a median follow-up of 1126 days (range, 362 to 1469) for living patients, the overall survival was 50% and relapse-free survival was 43%. Of 7 deaths, 3 were due to relapse and 4 to transplantation-related complications. We conclude that 9 Gy TMI can be combined with myeloablative chemotherapy in the design of new preparative regimens for HSCT. This study was registered at clinicaltrials.gov as NCT00988013.

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Section: Introductionmentioning

confidence: 99%

Combination of Linear Accelerator–Based Intensity-Modulated Total Marrow Irradiation and Myeloablative Fludarabine/Busulfan: A Phase I Study

Patel

Aydogan

Koshy

et al. 2014

Biology of Blood and Marrow Transplantation

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“…[2][3][4] Organ sparing depends on the organs' anatomical size and location, with median dose reduction varying 30 -90% of the prescribed dose. 3 Because of the longitudinal travel limit of the HT treatment couch, TMI has to be split in 2 segments, defined as upper body and lower body, with the latter referring to the lower limbs. At City of Hope Cancer Center, patients receive TMI with HT for the upper body only (i.e., from vertex to midlevel of the femurs), and the remaining portion of the legs are treated with a conventional linear accelerator (linac).…”

Section: Introductionmentioning

confidence: 99%

Advances in the implementation of helical tomotherapy–based total marrow irradiation with a novel field junction technique

et al. 2012

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“…31 One of the main aims for the recently developed total marrow irradiation (TMI) method is to reduce radiation dose to lungs to control lung toxicity. 5,6,32 At present, safety margins around the thoracic bone are kept the same (approximately 1.5 cm) for all directions because of limited knowledge of the directional chest wall motion. Breathing motion data shows a relatively larger variation in the diaphragm, in comparison to the apex and thoracic regions of the chest.…”

Section: Discussionmentioning

confidence: 99%

“…Recently, total marrow irradiation is being explored as a part of the hematopoietic cell transplantation (HCT) preparative regimen. [1][2][3][4] We have developed methodologies for selective total marrow irradiation (TMI) using tomotherapy, 5,6 which has a potential to replace the current method of total body irradiation (TBI). Tomotherapy is an image guided radiation therapy machine that delivers conformed radiation helically around the patient.…”

Section: Introductionmentioning

confidence: 99%

Feasibility of intrafraction whole-body motion tracking for total marrow irradiation

et al. 2011

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Abstract. With image-guided tomotherapy, highly targeted total marrow irradiation (TMI) has become a feasible alternative to conventional total body irradiation. The uncertainties in patient localization and intrafraction motion of the whole body during hour-long TMI treatment may pose a risk to the safety and accuracy of targeted radiation treatment. The feasibility of near-infrared markers and optical tracking system (OTS) is accessed along with a megavoltage scanning system of tomotherapy. Three near-infrared markers placed on the face of a rando phantom are used to evaluate the capability of OTS in measuring changes in the markers' positions as the rando is moved in the translational direction. The OTS is also employed to determine breathing motion related changes in the position of 16 markers placed on the chest surface of human volunteers. The maximum uncertainty in locating marker position with the OTS is 1.5 mm. In the case of normal and deep breathing motion, the maximum marker position change is observed in anterior-posterior direction with the respective values of 4 and 12 mm. The OTS is able to measure surface changes due to breathing motion. The OTS may be optimized to monitor whole body motion during TMI to increase the accuracy of treatment delivery and reduce the radiation dose to the lungs. C 2011 Society of Photo-Optical Instrumentation Engineers (SPIE).

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Helical tomotherapy targeting total bone marrow – First clinical experience at the University of Minnesota

Cited by 53 publications

References 14 publications

Combination of Linear Accelerator–Based Intensity-Modulated Total Marrow Irradiation and Myeloablative Fludarabine/Busulfan: A Phase I Study

Combination of Linear Accelerator–Based Intensity-Modulated Total Marrow Irradiation and Myeloablative Fludarabine/Busulfan: A Phase I Study

Advances in the implementation of helical tomotherapy–based total marrow irradiation with a novel field junction technique

Feasibility of intrafraction whole-body motion tracking for total marrow irradiation

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