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Updated: Oct 28, 2026
Treatment of Liver Metastases Using an Internal Target Volume Method for Stereotactic Body Radiotherapy
Published on: May 8, 2018
Hypofractionated Total Marrow and Lymphoid Irradiation for Relapsed/Refractory Leukemia Using Helical Tomotherapy:
Wenjie Ni1, Xiunan Wang1, Hui Yang1
1Department of Radiation Oncology, Beijing Shijitan Hospital, Capital Medical University, Beijing, China.
Purpose:
To report the workflow optimization, dosimetric characteristics, and clinical outcomes of hypofractionated total marrow irradiation (TMI) and total marrow and lymphoid irradiation (TMLI) as part of conditioning regimens for patients with relapsed or refractory leukemia undergoing hematopoietic stem cell transplantation (HSCT).
Materials And Methods:
Ninety-two patients treated between December 2024 and October 2025 were retrospectively analyzed. Prescription doses ranged from 10.5 to 15.0 Gy, delivered in once-daily fractions of 3.0-4.0 Gy. Patients were grouped by prescription dose (10.5-12.0 Gy, n=72 vs. 14.0-15.0 Gy, n=20). Dosimetric parameters of planning target volumes and organs at risk (OARs) were extracted. Survival outcomes were analyzed using Kaplan-Meier analysis.
Results:
Adequate target coverage was achieved in both dose groups, with median planning target volume D95% values of 100.0% and 99.5% for the 10.5-12.0 Gy and 14.0-15.0 Gy groups, respectively. Lung mean doses were limited to 6.2±0.7 Gy and 6.6±0.8 Gy, and mean oral cavity doses were 6.2±1.5 Gy and 5.6±1.0 Gy, respectively. Mean rib doses were intentionally reduced to approximately 10 Gy to prioritize lung sparing. Eighty-seven out of 92 patients successfully underwent HSCT (94.6%), and 8 died of transplant-related causes (8.7%). The overall incidence of chronic graft-versus-host disease was 62.0%. One-year disease-free survival and overall survival were 78.4% and 87.0%, respectively.
Conclusion:
Hypofractionated TMI and TMLI are feasible and efficient conditioning approaches for relapsed or refractory leukemia, providing adequate target coverage with effective OAR sparing. The toxicity and clinical outcomes were acceptable.
