Studinski R C N, Fraser D J, Samant R S, MacPherson M S
Department of Medical Physics, The Ottawa Hospital Cancer Centre, Ottawa, ON.
Department of Radiation Oncology, The Ottawa Hospital Cancer Centre, Ottawa, ON.
Curr Oncol. 2017 Jun;24(3):181-186. doi: 10.3747/co.24.3484. Epub 2017 Jun 27.
Total-body irradiation (tbi) is used to condition patients before bone marrow transplant. A variety of tbi treatment strategies have been described and implemented, but no consensus on best practice has been reached. We report on the results of a survey created to assess the current state of tbi delivery in Canada.
A 19-question survey was distributed to 49 radiation oncology programs in Canada. Responses were received from 20 centres, including 12 centres that perform tbi. A variety of tbi dose prescriptions was reported, although 12 Gy in 6 fractions was used in 11 of the 12 centres performing tbi. Half of the centres also reported using a dose prescription unique to their facility. Most centres use an extended-distance parallel-opposed-pair technique, with the patient standing or lying on a stretcher against a wall. Others translate the patient under the beam, sweep the beam over the patient, or use a more complicated multi-field technique. All but 1 centre indicated that they attenuate the lung dose; only 3 centres indicated attenuating the dose for other organs at risk. The survey also highlighted the considerable resources used for tbi, including extra staff, prolonged planning and treatment times, and use of locally developed hardware or software.
At transplant centres, tbi is commonly used, but there is no commonly accepted approach to planning and treatment delivery. The important discrepancies in practice between centres in Canada creates an opportunity to prompt more discussion and collaboration between centres, improving consistency and uniformity of practice.
全身照射（TBI）用于骨髓移植前对患者进行预处理。已经描述并实施了多种TBI治疗策略，但尚未就最佳实践达成共识。我们报告了一项旨在评估加拿大TBI治疗现状的调查结果。
向加拿大49个放射肿瘤学项目发放了一份包含19个问题的调查问卷。收到了20个中心的回复，其中包括12个进行TBI治疗的中心。报告了多种TBI剂量处方，尽管在进行TBI治疗的12个中心中有11个使用6次分割、每次12 Gy的剂量。一半的中心还报告使用了其机构特有的剂量处方。大多数中心采用延长距离的平行相对野技术，患者站在或躺在靠墙的担架上。其他中心则将患者在射线下移动、使射线扫过患者，或使用更复杂的多野技术。除1个中心外，所有中心均表示会对肺部剂量进行衰减；只有3个中心表示会对其他危及器官的剂量进行衰减。该调查还突出了TBI治疗所使用的大量资源，包括额外的工作人员、延长的计划和治疗时间，以及使用本地开发的硬件或软件。
在移植中心，TBI治疗被普遍使用，但在计划和治疗实施方面没有普遍接受的方法。加拿大各中心在实践中的重要差异为促使各中心之间进行更多讨论和合作创造了机会，从而提高实践的一致性和统一性。
