Dept. of Radiation Oncology, University Medical Center Utrecht, The Netherlands; Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands.
Dept. of Radiation Oncology, University Hospital, LMU Munich, Germany.
Radiother Oncol. 2022 Aug;173:119-133. doi: 10.1016/j.radonc.2022.05.027. Epub 2022 May 31.
Myeloablative Total Body Irradiation (TBI) is an important modality in conditioning for allogeneic hematopoietic stem cell transplantation (HSCT), especially in children with high-risk acute lymphoblastic leukemia (ALL). TBI practices are heterogeneous and institution-specific. Since TBI is associated with multiple late adverse effects, recommendations may help to standardize practices and improve the outcome versus toxicity ratio for children.
The European Society for Paediatric Oncology (SIOPE) Radiotherapy TBI Working Group together with ESTRO experts conducted a literature search and evaluation regarding myeloablative TBI techniques and toxicities in children. Findings were discussed in bimonthly virtual meetings and consensus recommendations were established.
Myeloablative TBI in HSCT conditioning is mostly performed for high-risk ALL patients or patients with recurring hematologic malignancies. TBI is discouraged in children <3-4 years old because of increased toxicity risk. Publications regarding TBI are mostly retrospective studies with level III-IV evidence. Preferential TBI dose in children is 12-14.4 Gy in 1.6-2 Gy fractions b.i.d. Dose reduction should be considered for the lungs to <8 Gy, for the kidneys to ≤10 Gy, and for the lenses to <12 Gy, for dose rates ≥6 cGy/min. Highly conformal techniques i.e. TomoTherapy and VMAT TBI or Total Marrow (and/or Lymphoid) Irradiation as implemented in several centers, improve dose homogeneity and organ sparing, and should be evaluated in studies.
These ESTRO ACROP SIOPE recommendations provide expert consensus for conventional and highly conformal myeloablative TBI in children, as well as a supporting literature overview of TBI techniques and toxicities.
全身照射（TBI）是异基因造血干细胞移植（HSCT）预处理的重要手段，尤其是对高危急性淋巴细胞白血病（ALL）患儿。TBI 的应用实践存在差异且具有机构特异性。由于 TBI 与多种晚期不良反应相关，因此相关建议有助于规范 TBI 应用实践，提高患儿的疗效-毒性比。
欧洲小儿肿瘤学会（SIOPE）放射治疗 TBI 工作组与欧洲放射肿瘤学会（ESTRO）专家合作，对儿童 TBI 技术和毒性方面的相关研究进行了文献检索和评估。研究结果在双月虚拟会议上进行了讨论，并制定了共识推荐意见。
在 HSCT 预处理中，TBI 主要用于高危 ALL 患儿或复发血液系统恶性肿瘤患儿。由于毒性风险增加，不建议 3-4 岁以下儿童进行 TBI。关于 TBI 的出版物多为 III-IV 级证据的回顾性研究。儿童 TBI 的首选剂量为 12-14.4Gy，1.6-2Gy 分次，每日 2 次。肺部剂量应降至<8Gy，肾脏剂量应降至≤10Gy，晶状体剂量应降至<12Gy，剂量率应≥6cGy/min。在一些中心实施的高度适形技术（如 TomoTherapy 和 VMAT TBI 或全骨髓（和/或淋巴）照射）可改善剂量均匀性和器官保护，应在研究中进行评估。
这些 ESTRO ACROP-SIOPE 推荐意见为儿童常规和高度适形 TBI 提供了专家共识，同时对 TBI 技术和毒性方面的文献进行了综述。
Zotero 插件