Optimised conformal total body irradiation: a heterogeneous practice, so where next?

Abstract

The use of volumetric arc therapy (VMAT) and inverse planning has been in routine use in radiotherapy for two decades. However, use in total body irradiation (TBI) has been more recent and few guidelines exist as to how to plan or verify. This has led to heterogeneous approaches. The goal of this review is to provide an overview of current advanced planning and dosimetry verification protocols used in optimised conformal TBI as a basis for investigating the need for greater standardisation in TBI.

Treatment robustness of total body irradiation with volumetric modulated arc therapy

“…Multi-isocenter Volumetric Modulated Arc Therapy (VMAT) for Total Body Irradiation (TBI) has been introduced in various centers [1] , [2] , [3] , [4] , [5] . Early adopters describe their techniques as single-center efforts [2] , [3] , [6] , with a variety of implementation solutions and patient position verification (PPV) imaging workflows [7] . VMAT-TBI delivery is sensitive to patient positioning errors due to the dose matching of multiple isocenters [8] and arcs simulated on different patient orientation (Head First Supine (HFS) and Feet First Supine (FFS) position) computed tomography (CT) scans [9] .…”