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Pulmonary Toxicities in Pediatric Patients Treated With Total Body Irradiation Using the Lateral Opposed Fields
Natalie Boyce1, Safia Ahmed2, W Scott Harmsen3
1Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA.
Insights
Pulmonary toxicity (PT) occurred in 33% of pediatric patients after total body irradiation (TBI). Preventing graft-versus-host disease (GVHD) and using low TBI dose rates can reduce PT risk and improve survival.
Area of Science:
- Pediatric oncology
- Radiation oncology
- Hematopoietic stem cell transplantation
Background:
- Pulmonary toxicity (PT) is a significant concern following total body irradiation (TBI) in pediatric patients undergoing stem cell transplantation.
- Understanding the incidence and risk factors for PT is crucial for improving patient outcomes.
Purpose of the Study:
- To determine the incidence and associated factors of pulmonary toxicity (PT) in pediatric patients treated with total body irradiation (TBI) using a lateral opposed fields technique.
- To evaluate the impact of PT on overall survival (OS).
Main Methods:
- Retrospective review of medical records for 61 pediatric patients (≤21 years) treated with TBI between 1993-2017.
- Recording incidences of PT, graft-versus-host disease (GVHD), and other toxicities.
- Analyzing associations between PT and clinical variables using chi-square tests and estimating overall survival (OS) with Kaplan-Meier methods.
Main Results:
- Three-year OS was 65%. PT occurred in 33% of patients.
- A higher PT rate was observed in patients with GVHD (65% vs. 35%, p ≤ 0.01).
- Higher TBI dose rates increased PT risk (HR = 1.9, p = 0.04), and PT was associated with inferior OS (HR = 3.4, p = 0.01).
Conclusions:
- The cohort treated with low dose rate TBI (4.0-10 cGy/min) experienced an acceptable PT incidence.
- PT, noninfectious PT, and pneumonitis significantly correlated with reduced survival.
- Future strategies should focus on preventing GVHD and utilizing low TBI dose rates to mitigate PT and improve outcomes.
Purpose:
Pulmonary toxicity (PT) remains a concern following total body irradiation (TBI). This study describes the incidence and factors associated with PT in a cohort of patients homogeneously treated with the lateral opposed fields technique.
Methods:
Medical records of 61 patients ≤21 years of age treated with TBI as a component of stem cell transplantation from 1993-2017 were retrospectively reviewed. The incidences of PT, graft-versus-host disease (GVHD), and other toxicities were recorded for each patient. PT was subdivided into its etiologies, and symptomatic PT was established by clinical diagnosis. The association of PT with other variables was examined using chi-square tests, and overall survival (OS) was estimated using Kaplan-Meier.
Results:
Three-year OS was 65% (54%-79%). Median TBI dose rate was 7.7 cGy/min (4.0-10 cGy/min). PT occurred in 20 patients (33%). A higher rate of PT was observed in patients with GVHD (65% vs. 35%, p ≤ 0.01). TBI dose rate (
Conclusions:
This cohort of patients treated with a low dose rate, bilateral technique, and total dose of 1000-1320 cGy experienced an acceptable incidence of PT, comparable to other published studies. Because PT correlated with reduced survival, current practice should seek to address factors associated with PT by aiming to prevent GVHD and by choosing low dose rates, such as in the range of 4.0-10 cGy/min.
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