Furka Andrea, Nagy Zsofia, Szabó Imre, Fekete Gábor, Kelemen Ágnes, Bolobás Gábor, Sebők Gábriel, Molnár Tünde, Árvai János, Tornyi Ilona, Kostyál László, Révész János, Hauser Peter
Department of Oncology, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary.
Department of Clinical Radiology, Faculty of Health Care, Institute of Practical Methodology and Diagnostics, University of Miskolc, 3526 Miskolc, Hungary.
Children (Basel). 2022 Nov 12;9(11):1740. doi: 10.3390/children9111740.
Total body irradiation (TBI) 2 × 2 Gy for 3 consecutive days followed by chemotherapy for conditioning pediatric patients with acute lymphoid leukemia (ALL) before bone marrow transplantation is superior to chemo-conditioning alone. The globally used anterior-posterior/posterior-anterior (AP/PA) technique is the most referable method, but volumetric modulated arc therapy (VMAT) with modern linear accelerators is more precise in terms of ensuring better dose distribution, especially for skin, and higher protection of organs at risk, resulting in less side effects.
For TBI, a modern VMAT technique was used. Whole-body immobilization in the supine position was performed using a vacuum mattress with a full body coverage, with a water-equivalent bolus of 1 cm thickness. The design goal was to achieve dose inhomogeneity of less than ±10%.
From 2020 to 2022, we performed TBI for five pediatric patients with ALL, with full body bolus and VMAT, who later received hematopoietic stem cell transplantation. No acute complications related to TBI were observed during the treatment period with a median follow-up of 1.27 (0.43-2.11) years.
Using full body water-equivalent bolus with VMAT for TBI provides a safe method for children with a better organ sparing in the short term follow-up.
在骨髓移植前，对小儿急性淋巴细胞白血病（ALL）患者进行预处理时，连续3天每天2次全身照射（TBI），每次2 Gy，随后进行化疗，优于单纯化疗预处理。全球普遍使用的前后/后前（AP/PA）技术是最值得推荐的方法，但使用现代直线加速器的容积调强弧形放疗（VMAT）在确保更好的剂量分布方面更精确，尤其是对皮肤，并且对危及器官的保护更高，副作用更少。
对于TBI，采用现代VMAT技术。使用全身覆盖的真空床垫在仰卧位进行全身固定，使用厚度为1 cm的水等效填充物。设计目标是实现剂量不均匀性小于±10%。
2020年至2022年，我们对5例患有ALL的小儿患者进行了TBI，采用全身填充物和VMAT，这些患者随后接受了造血干细胞移植。在中位随访1.27（0.43 - 2.11）年的治疗期间，未观察到与TBI相关的急性并发症。
在短期随访中，使用全身水等效填充物结合VMAT进行TBI为儿童提供了一种安全的方法，能更好地保护器官。
