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

Abstract

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.

Total Body Irradiation in Haematopoietic Stem Cell Transplantation for Paediatric Acute Lymphoblastic Leukaemia: Review of the Literature and Future Directions

“…If an isocentrically commissioned TPS is used at extended SSDs, the accuracy of the TPS must be verified for that specific geometry because the beam may have a different energy spectrum, resulting in a change in the depth-dose distributions and a larger component of in-room scatter to the patient dose ( 275 ). If verified under extended SSD conditions, an isocentric TPS can be used to calculate dose distributions from more complex techniques such as “step and shoot” IMRT ( 123 , 155 , 276 ) ( Figure 2A ) or extended SSD VMAT ( 277 , 278 ).…”

Commissioning of a three‐dimensional arc‐based technique for total body irradiation

“…3 In the literature, a growing but still low number of papers deal with three‐dimensional treatment planning issues. 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 …”

“…Because TBI is a complex radiotherapy treatment, most institutions use very simple treatment planning approaches and a homogenous dose calculation, being traditionally delivered using two‐dimensional (2D) techniques with a conventional linac (linear accelerator) using an anterior–posterior (AP/PA) or parallel‐opposed lateral beam arrangements at an extended source‐to‐surface distance (SSD) 3 . In the literature, a growing but still low number of papers deal with three‐dimensional treatment planning issues 6‐13 …”