Total body irradiation for bone marrow transplantation: The Memorial sloan-Kettering cancer center experience

Shank, Brenda; O’Reilly, Richard J.; Cunningham, Isabel; Kernan, Nancy A.; Yaholom, Joachim; Brochstein, Joel A.; Castro‐Malaspina, Hugo; Kutcher, Gerald J.; Mohan, Rahde; Bonfiglio, Patricia

doi:10.1016/0167-8140(90)90180-5

Cited by 61 publications

(35 citation statements)

References 16 publications

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“…8,9 Prognostic factors and TBI parameters, except for testicular irradiation, were tested as risk factors for OS and relapse in univariate and/or multivariate analyses. Although reported to reduce the risk of relapse, 10 testicular irradiation was not analysed because only a minority of patients received it. Autologous and allogeneic transplants were analysed separately because GVHD, which was considered a time-dependent variable, is found only in allogeneic transplantation.…”

Section: Discussionmentioning

confidence: 99%

“…The team postulated that small irradiation doses would increase the total dose and showed that hyper-fractionation exerted an effect on the cell cycle with a build-up of cells in the more radiosensitive phases. 10,14 Both factors exerted a greater anti-leukemic effect. 10 The extra dose was added in Perugia with the aim of overcoming the high risks of rejection and relapse that are associated with extensive T cell depletion of the graft.…”

Section: Impact Of Tbi On Transplantation Outcomes C Aristei Et Almentioning

confidence: 99%

“…10,14 Both factors exerted a greater anti-leukemic effect. 10 The extra dose was added in Perugia with the aim of overcoming the high risks of rejection and relapse that are associated with extensive T cell depletion of the graft. Clinical outcomes confirmed the efficacy of this TBI schedule which was, however, combined with ATG, thiotepa, and CY or, more recently, fludarabine [15][16][17] to increase the myeloablative power of the conditioning regimen.…”

Section: Impact Of Tbi On Transplantation Outcomes C Aristei Et Almentioning

confidence: 99%

“…It was derived from the 13.2 Gy fractionated into 1.2 Gy thrice daily schedule, which was designed by Shank et al 10 at Memorial Sloan Kettering Cancer Center, New York. The team postulated that small irradiation doses would increase the total dose and showed that hyper-fractionation exerted an effect on the cell cycle with a build-up of cells in the more radiosensitive phases.…”

Section: Impact Of Tbi On Transplantation Outcomes C Aristei Et Almentioning

confidence: 99%

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In haematopoietic SCT for acute leukemia TBI impacts on relapse but not survival: results of a multicentre observational study

Aristei

Santucci

Corvò

et al. 2013

Bone Marrow Transplant

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The aim of this study was to determine whether parameters related to TBI impacted upon OS and relapse in patients with acute leukemia in CR who underwent haematopoietic SCT (HSCT) in 11 Italian Radiation Oncology Centres. Data were analysed from 507 patients (313 males; 194 females; median age 15 years; 318 with ALL; 188 with AML; 1 case not recorded). Besides 128 autologous transplants, donors included 192 matched siblings, 74 mismatched family members and 113 unrelated individuals. Autologous and allogeneic transplants were analysed separately. Median follow-up was 40.1 months. TBI schedules and HSCT type were closely related. Uni-and multi-variate analyses showed no parameter was significant for OS or relapse in autologous transplantation. Multivariate analysis showed type of transplant and disease impacted significantly on OS in allogeneic transplantation. Disease, GVHD and TBI dose were risk factors for relapse. This analysis illustrates that Italian Transplant Centre use of TBI is in line with international practice. Most Centres adopted a hyperfractionated schedule that is used worldwide (12 Gy in six fractions over 3 days), which appears to have become standard. TBI doses impacted significantly upon relapse rates.

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Section: Discussionmentioning

confidence: 99%

Section: Impact Of Tbi On Transplantation Outcomes C Aristei Et Almentioning

confidence: 99%

Section: Impact Of Tbi On Transplantation Outcomes C Aristei Et Almentioning

confidence: 99%

Section: Impact Of Tbi On Transplantation Outcomes C Aristei Et Almentioning

confidence: 99%

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In haematopoietic SCT for acute leukemia TBI impacts on relapse but not survival: results of a multicentre observational study

Aristei

Santucci

Corvò

et al. 2013

Bone Marrow Transplant

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“…( 6 , 7 ) Other clinical situations where the applicator leakage poses a significant risk to patients include exposure of the shoulders to leakage radiation when treating neck nodes at extended SSD, and exposure of the legs to leakage during testicular boosts for TBI. ( 8 , 9 ) In addition, it is well known that exposure of large volumes of normal tissues to low doses of radiation increases an individual's risk of developing a radiation‐induced secondary cancer. Moreover, for patients undergoing electron beam therapy who have implanted cardiac pacemakers and defibrillators, excessive leakage radiation can contribute significantly to the dose absorbed by these devices and, as a result, can adversely affect their function.…”

Section: Introductionmentioning

confidence: 99%

Quantification and reduction of peripheral dose from leakage radiation on Siemens primus accelerators in electron therapy mode

Yeboah¹,

Karotki²,

Hunt³

et al. 2010

J Applied Clin Med Phys

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In this work, leakage radiation from EA200 series electron applicators on Siemens Primus accelerators is quantified, and its penetration ability in water and/or the shielding material Xenolite‐NL established. Initially, measurement of leakage from 10×10−25×25 cm2 applicators was performed as a function of height along applicator and of lateral distance from applicator body. Relative to central‐axis ionization maximum in solid water, the maximum leakage in air observed with a cylindrical ion chamber with 1 cm solid water buildup cap at a lateral distance of 2 cm from the front and right sidewalls of applicators were 17% and 14%, respectively; these maxima were recorded for 18 MeV electron beams and applicator sizes of ≥20×20 cm2. In the patient plane, the applicator leakage gave rise to a broad peripheral dose off‐axis distance peak that shifted closer to the field edge as the electron energy increases. The maximum peripheral dose from normally incident primary electron beams at a depth of 1 cm in a water phantom was observed to be equal to 5% of the central‐axis dose maximum and as high as 9% for obliquely incident beams with angles of obliquity ≤ 40°. Measured depth‐peripheral dose curves showed that the “practical range” of the leakage electrons in water varies from approximately 1.4 to 5.7 cm as the primary electron beam energy is raised from 6 to 18 MeV. Next, transmission measurements of leakage radiation through the shielding material Xenolite‐NL showed a 4 mm thick sheet of this material is required to attenuate the leakage from 9 MeV beams by two‐thirds, and that for every additional 3 MeV increase in the primary electron beam energy, an additional Xenolite‐NL thickness of roughly 2 mm is needed to achieve the aforementioned attenuation level. Finally, attachment of a 1 mm thick sheet of lead to the outer surface of applicator sidewalls resulted in a reduction of the peripheral dose by up to 80% and 74% for 9 and 18 MeV beams, respectively. This sidewall modification had an insignificant effect on the clinical depth dose, cross‐axis beam profiles, and output factors.PACS numbers: 87.53.Bn, 87.56.bd, 87.56.J‐

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Radiotherapeutic Principles of Hematopoietic Cell Transplantation

Shank¹,

Hoppe²

2003

Thomas' Hematopoietic Cell Transplantation

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Total body irradiation for bone marrow transplantation: The Memorial sloan-Kettering cancer center experience

Cited by 61 publications

References 16 publications

In haematopoietic SCT for acute leukemia TBI impacts on relapse but not survival: results of a multicentre observational study

In haematopoietic SCT for acute leukemia TBI impacts on relapse but not survival: results of a multicentre observational study

Quantification and reduction of peripheral dose from leakage radiation on Siemens primus accelerators in electron therapy mode

Radiotherapeutic Principles of Hematopoietic Cell Transplantation

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