Hematology Division, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan.
Department of Radiology, Division of Radiation Oncology, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan.
Ann Med. 2022 Dec;54(1):2616-2625. doi: 10.1080/07853890.2022.2125171.
Intensity-modulated radiation therapy (IMRT) helps achieve good radiation dose conformity and precise dose evaluation. We conducted a single-centre prospective study to assess the safety and feasibility of total body irradiation with IMRT (IMRT-TBI) using helical tomotherapy in allogeneic haematopoietic stem cell transplantation (allo-HSCT).
Thirty-nine adult patients with haematological malignancy (acute lymphoblastic leukaemia [ = 21], chronic myeloid leukaemia [ = 6], mixed phenotype acute leukaemia [ = 5], acute myeloid leukaemia [ = 4], and malignant lymphoma [ = 3]) who received 12 Gy IMRT-TBI were enrolled with a median follow-up of 934.5 (range, 617-1254) d. At the time of transplantation, 33 patients (85%) achieved complete remission. The conditioning regimen used IMRT-TBI (12 Gy in 6 fractions twice daily, for 3 d) and cyclophosphamide (60 mg/kg/d, for 2 d), seven patients were combined with cytarabine, and five with etoposide. We set dose constraints for the lungs, kidneys and lens as the organs at risk.
The mean doses for the lungs and kidneys were 7.50 and 9.11 Gy, respectively. The mean maximum dose for the lens (right/left) was 5.75/5.87 Gy. The 2-year overall survival (OS), disease-free survival (DFS), cumulative incidence of relapse (CIR) and non-relapse mortality (NRM) were 69, 64, 18 and 18%, respectively. Thirty-six patients developed early adverse events (AEs) (including four patients with Grade 3/4 toxicities), most of which were reversible oral mucositis and may partially have been related to IMRT-TBI. However, the incidence of toxicity was comparable to conventional TBI-based conditioning transplantation. None of the patients developed primary graft failure, or Grade III-IV acute graft-versus-host disease (GVHD). In late complications, chronic kidney disease was observed in six patients, a lower incidence compared to conventional TBI-based conditioning transplantation. No radiation pneumonitis or cataracts were observed in any of the patients.
IMRT-TBI is safe and feasible for haematological malignancies with acceptable clinical outcomes.KEY MESSAGESIMRT-TBI-helical tomotherapy aids in accurate dose calculation and conformity.It could be used without any considerable increase in the rate of TBI-related AEs.Allo-HSCT with IMRT-TBI may be an alternative to conventional TBI for clinical use.
调强放疗（IMRT）有助于实现良好的放射剂量一致性和精确的剂量评估。我们进行了一项单中心前瞻性研究，评估了在异基因造血干细胞移植（allo-HSCT）中使用螺旋断层放疗（TBI）进行全身放疗（IMRT-TBI）的安全性和可行性。
39 例血液系统恶性肿瘤患者（急性淋巴细胞白血病[21 例]、慢性髓性白血病[6 例]、混合表型急性白血病[5 例]、急性髓性白血病[4 例]和恶性淋巴瘤[3 例]）接受了 12Gy 的 IMRT-TBI，中位随访时间为 934.5（范围为 617-1254）d。移植时，33 例（85%）患者达到完全缓解。预处理方案为 IMRT-TBI（12Gy 分 6 次，每天 2 次，共 3d）和环磷酰胺（60mg/kg/d，共 2d），7 例联合使用阿糖胞苷，5 例联合使用依托泊苷。我们为肺、肾和晶状体等危险器官设定了剂量限制。
肺和肾的平均剂量分别为 7.50 和 9.11Gy。晶状体（右眼/左眼）的平均最大剂量为 5.75/5.87Gy。2 年总生存率（OS）、无病生存率（DFS）、累积复发率（CIR）和非复发死亡率（NRM）分别为 69%、64%、18%和 18%。36 例患者发生早期不良反应（AE）（包括 4 例 3/4 级毒性），多数为可逆性口腔黏膜炎，部分可能与 IMRT-TBI 相关。然而，毒性的发生率与基于常规 TBI 的预处理移植相当。无 1 例患者发生原发性移植物失败或 3/4 级急性移植物抗宿主病（GVHD）。在晚期并发症中，6 例患者发生慢性肾脏病，发生率低于基于常规 TBI 的预处理移植。无 1 例患者发生放射性肺炎或白内障。
IMRT-TBI 安全可行，适用于血液系统恶性肿瘤，临床结局可接受。
关键信息
IMRT-TBI-螺旋断层放疗有助于精确的剂量计算和一致性。
可以在不增加 TBI 相关不良反应发生率的情况下使用。
allo-HSCT 联合 IMRT-TBI 可能是常规 TBI 的替代方案，可供临床使用。
Zotero 插件