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Total body irradiation using a modified standing technique: a single institution 7 year experience
S V Harden1, D S Routsis, A R Geater
1Department of Clinical Oncology, Box 193, Addenbrooke's Hospital, Hills Road, Cambridge CB2 2QQ, UK.
The British Journal of Radiology
|November 16, 2001
Summary
A novel standing technique for total body irradiation (TBI) allows accurate lung dose calculation, minimizing pneumonitis risk. This method, used before bone marrow transplantation, proved well-tolerated and efficient.
Area of Science:
- Radiation Oncology
- Medical Physics
- Hematology
Background:
- Total body irradiation (TBI) is crucial for bone marrow transplantation.
- Delivering TBI with large fields typically requires specialized equipment and facilities.
- Minimizing lung toxicity is a significant challenge in TBI protocols.
Purpose of the Study:
- To describe a simple standing technique for delivering TBI using a non-dedicated unit.
- To evaluate the accuracy and safety of this TBI technique, particularly regarding lung dose.
- To assess the clinical outcomes, including respiratory toxicity, in patients undergoing bone marrow transplantation with this TBI method.
Main Methods:
- A standing TBI technique was developed using large horizontal fields with an off-centre installed treatment unit.
- Patients received fractionated TBI with anterior and posterior fields and customized lung compensators.
- Dose distributions were verified, and clinical outcomes were retrospectively analyzed for 94 patients.
Main Results:
- The technique was well-tolerated, with setup times under 10 minutes.
- Dose delivery accuracy was within +/-6% for trunk/head and +/-5% for lungs.
- Respiratory deaths occurred in 17% of allogeneic transplant patients, with 3 attributed to infection.
Conclusions:
- This standing TBI technique is a feasible and efficient method for fractionated TBI prior to bone marrow transplantation.
- Customized lung compensators effectively allow for accurate dose calculation and modification, reducing lung overdose.
- While generally well-tolerated, careful monitoring for respiratory complications, especially in allogeneic transplant recipients, remains essential.