Influence of Total Body Irradiation Dose Rate on Idiopathic Pneumonia Syndrome in Acute Leukemia Patients Undergoing Allogeneic Hematopoietic Cell Transplantation

Gao, Robert W.; Weisdorf, Daniel J.; DeFor, Todd E.; Ehler, E.; Dusenbery, Kathryn E.

doi:10.1016/j.ijrobp.2018.09.002

Cited by 43 publications

(29 citation statements)

References 38 publications

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“…We selected an energy of 6 MV photons and a nominal maximum dose rate of 600 MU/min for this work. For conventional treatments it is recommended to keep the dose rate below 20 cGy/min or even 10 cGy/min to minimize lung toxicities 2,10,31 . However, there is not an accurate way to compare the influence of dose rates between modulated and nonmodulated treatments.…”

Section: Discussionmentioning

confidence: 99%

“…Interstitial pneumonitis is the major side effect from highdose TBI radiation therapy and can be fatal in some instances. 1,[9][10][11] Additionally, high-dose TBI treatments can produce late toxicities, such as chronic kidney dysfunction and secondary malignancies. [12][13][14][15] In order to mitigate TBI-induced acute and chronic side effects, the use of shielding blocks, particularly for lungs and in some instances for kidneys, is widely accepted in high-dose TBI treatments.…”

Section: According To the International Lymphoma Radiation Oncologymentioning

confidence: 99%

“…One of the main drawbacks of at‐distance open beam treatments used for TBI is the inability for selective sparing of organs at risk (OARs). Interstitial pneumonitis is the major side effect from high‐dose TBI radiation therapy and can be fatal in some instances 1,9–11 . Additionally, high‐dose TBI treatments can produce late toxicities, such as chronic kidney dysfunction and secondary malignancies 12–15 .…”

Section: Introductionmentioning

confidence: 99%

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Automatic treatment planning for VMAT‐based total body irradiation using Eclipse scripting

Teruel¹,

Taneja²,

Galavis³

et al. 2021

J Applied Clin Med Phys

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The purpose of this work is to establish an automated approach for a multiple isocenter volumetric arc therapy (VMAT)-based TBI treatment planning approach. Five anonymized full-body CT imaging sets were used. A script was developed to automate and standardize the treatment planning process using the Varian Eclipse v15.6 Scripting API. The script generates two treatment plans: a headfirst VMAT-based plan for upper body coverage using four isocenters and a total of eight full arcs; and a feet-first AP/PA plan with three isocenters that covers the lower extremities of the patient. PTV was the entire body cropped 5 mm from the patient surface and extended 3 mm into the lungs and kidneys. Two plans were generated for each case: one to a total dose of 1200 cGy in 8 fractions and a second one to a total dose of 1320 cGy in 8 fractions. Plans were calculated using the AAA algorithm and 6 MV photon energy. One plan was created and delivered to an anthropomorphic phantom containing 12 OSLDs for in-vivo dose verification. For the plans prescribed to 1200 cGy total dose the following dosimetric results were achieved: median PTV V100% = 94.5%; median PTV D98% = 89.9%; median lungs Dmean = 763 cGy; median left kidney Dmean = 1058 cGy; and median right kidney Dmean = 1051 cGy. For the plans prescribed to 1320 cGy total dose the following dosimetric results were achieved: median PTV V100% = 95.0%; median PTV D98% = 88.7%; median lungs Dmean = 798 cGy; median left kidney Dmean = 1059 cGy; and median right kidney Dmean = 1064 cGy. Maximum dose objective was met for all cases. The dose deviation between the treatment planning dose and the dose measured by the OSLDs was within AE4%. In summary, we have demonstrated that scripting can produce high-quality plans based on predefined dose objectives and can decrease planning time by automatic target and optimization contours generation, plan creation, field and isocenter placement, and optimization objectives setup.

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Section: Discussionmentioning

confidence: 99%

Section: According To the International Lymphoma Radiation Oncologymentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Automatic treatment planning for VMAT‐based total body irradiation using Eclipse scripting

Teruel¹,

Taneja²,

Galavis³

et al. 2021

J Applied Clin Med Phys

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“…Gao et al . previously reported that a dose rate ≥15 cGy/min significantly increased the risk of post-transplantation idiopathic pneumonia syndrome [ 25 ]. In our institution, the DMU, SF and TPR 28,10 were 0.0585 cGy/MU, 0.976 and 0.654, respectively.…”

Section: Discussionmentioning

confidence: 99%

Commissioning of total body irradiation using plastic bead bags

Akino

Maruoka

Yano

et al. 2020

Journal of Radiation Research

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The goal of total body irradiation (TBI) is to deliver a dose to the whole body with uniformity within ±10%. The purpose of this study was to establish the technique of TBI using plastic bead bags. A lifting TBI bed, Model ORP-TBI-MN, was used. The space between the patient’s body and the acrylic walls of the bed was filled with polyacetal bead bags. Patients were irradiated by a 10 MV photon beam with a source to mid-plane distance of 400 cm. The monitor unit (MU) was calculated by dose-per-MU, tissue-phantom-ratio and a spoiler factor measured in solid water using an ionization chamber. The phantom-scatter correction factor, off-center ratio and the effective density of the beads were also measured. Diode detectors were used for in vivo dosimetry (IVD). The effective density of the beads was 0.90 ± 0.09. The point doses calculated in an I’mRT phantom with and without heterogeneity material showed good agreement, with measurements within 3%. An end-to-end test was performed using a RANDO phantom. The mean ± SD (range) of the differences between the calculated and IVD-measured mid-plane doses was 1.1 ± 4.8% (−5.9 to 5.0%). The differences between the IVD-measured doses and the doses calculated with Acuros XB of the Eclipse treatment planning system (TPS) were within 5%. For two patients treated with this method, the differences between the calculated and IVD-measured doses were within ±6% when excluding the chest region. We have established the technique of TBI using plastic bead bags. The TPS may be useful to roughly estimate patient dose.

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“…In particular, there has been work performed in the literature that investigates the relationship between dose rate and the incidence or lethality of pulmonary complications such as interstitial pneumonitis (IP) or radiation pneumonitis (RP). There has been prospective and retrospective evidence illustrating both an apparent dose rate effect, [10][11][12][13][14] and no statistically significant dose rate effect. [15][16][17][18][19] When considering the dataset as a whole, several problems are evident.…”

Section: B | Plan Parametersmentioning

confidence: 99%

Standardized flattening filter free volumetric modulated arc therapy plans based on anteroposterior width for total body irradiation

Frederick

Hudson

Balogh

et al. 2020

J Applied Clin Med Phys

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In this work, the feasibility of using flattening filter free (FFF) beams in volumetric modulated arc therapy (VMAT) total body irradiation (TBI) treatment planning to decrease protracted beam‐on times for these treatments was investigated. In addition, a methodology was developed to generate standardized VMAT TBI treatment plans based on patient physical dimensions to eliminate plan optimization time. A planning study cohort of 47 TBI patients previously treated with optimized VMAT ARC 6 MV beams was retrospectively examined. These patients were sorted into six categories depending on height and anteroposterior (AP) width at the umbilicus. Using Varian Eclipse, clinical 40 cm × 10 cm open field arcs were substituted with 6 MV FFF. Mid‐plane lateral dose profiles in conjunction with relative arc output factors (RAOF) yielded how far a given multileaf collimator (MLC) leaf must move in order to achieve a mid‐plane 100% isodose for a specific control point. Linear interpolation gave the dynamic MLC aperture for the entire arc for each patient AP width category, which was subsequently applied through Python scripting. All FFF VMAT TBI plans were then evaluated by two radiation oncologists and deemed clinically acceptable. The FFF and clinical VMAT TBI plans had similar Body–5 mm D98% distributions, but overall the FFF plans had statistically significantly increased or broader Body–5 mm D2% and mean lung dose distributions. These differences are not considered clinically significant. Median beam‐on times for the FFF and clinical VMAT TBI plans were 11.07 and 18.06 min, respectively, and planning time for the FFF VMAT TBI plans was reduced by 34.1 min. In conclusion, use of FFF beams in VMAT TBI treatment planning resulted in dose homogeneity similar to our current VMAT TBI technique. Clinical dosimetric criteria were achieved for a majority of patients while planning and calculated beam‐on times were reduced, offering the possibility of improved patient experience.

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Influence of Total Body Irradiation Dose Rate on Idiopathic Pneumonia Syndrome in Acute Leukemia Patients Undergoing Allogeneic Hematopoietic Cell Transplantation

Cited by 43 publications

References 38 publications

Automatic treatment planning for VMAT‐based total body irradiation using Eclipse scripting

Automatic treatment planning for VMAT‐based total body irradiation using Eclipse scripting

Commissioning of total body irradiation using plastic bead bags

Standardized flattening filter free volumetric modulated arc therapy plans based on anteroposterior width for total body irradiation

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