Radiation Oncology, University Hospital Bonn, Bonn, Germany.
Radiation Oncology, University Hospital Düsseldorf, Düsseldorf, Germany.
J Cancer Res Clin Oncol. 2023 Aug;149(10):7007-7015. doi: 10.1007/s00432-023-04657-7. Epub 2023 Mar 1.
Intensity-modulated helical tomotherapy (HT) is a promising technique in preparation for bone marrow transplantation. Nevertheless, radiation-sensitive organs can be substantially compromised due to suboptimal delivery techniques of total body irradiation (TBI). To reduce the potential burden of radiation toxicity to organs at risk (OAR), high-quality coverage and homogeneity are essential. We investigated dosimetric data from kidney, lung and thorax, liver, and spleen in relation to peripheral blood kinetics. To further advance intensity-modulated total body irradiation (TBI), the potential for dose reduction to lung and kidney was considered in the analysis.
46 patients undergoing TBI were included in this analysis, partially divided into dose groups (2, 4, 8, and 12 Gy). HT was performed using a rotating gantry to ensuring optimal reduction of radiation to the lungs and kidneys and to provide optimal coverage of other OAR. Common dosimetric parameters, such as D05, D95, and D50, were calculated and analysed. Leukocytes, neutrophils, platelets, creatinine, GFR, haemoglobin, overall survival, and graft-versus-host disease were related to the dosimetric evaluation using statistical tests.
The mean D95 of the lung is 48.23%, less than half the prescribed and unreduced dose. The D95 of the chest is almost twice as high at 84.95%. Overall liver coverage values ranged from 96.79% for D95 to 107% for D05. The average dose sparing of all patients analysed resulted in an average D95 of 68.64% in the right kidney and 69.31% in the left kidney. Average D95 in the spleen was 94.28% and D05 was 107.05%. Homogeneity indexes ranged from 1.12 for liver to 2.28 for lung. The additional significance analyses conducted on these blood kinetics showed a significant difference between the 2 Gray group and the other three groups for leukocyte counts. Further statistical comparisons of the dose groups showed no significant differences. However, there were significant changes in the dose of OAR prescribed with dose sparing (e.g., lung vs. rib and kidney).
Using intensity-modulated helical tomotherapy to deliver TBI is a feasible method in preparation for haematopoietic stem cell transplantation. Significant dose sparing in radiosensitive organs such as the lungs and kidneys is achievable with good overall quality of coverage. Peripheral blood kinetics support the positive impact of HT and its advantages strongly encourage its implementation within clinical routine.
调强螺旋断层放疗（HT）是骨髓移植准备的一项有前途的技术。然而，由于全身照射（TBI）的传递技术不理想，辐射敏感器官可能会受到严重影响。为了降低辐射毒性对危险器官（OAR）的潜在负担，高质量的覆盖和均匀性是必不可少的。我们研究了与外周血动力学相关的肾脏、肺和胸部、肝脏和脾脏的剂量学数据。为了进一步推进调强全身照射（TBI），我们在分析中考虑了降低肺和肾剂量的可能性。
本分析纳入了 46 名接受 TBI 的患者，部分分为剂量组（2、4、8 和 12Gy）。HT 采用旋转机架进行，以确保对肺部和肾脏的辐射得到最佳降低，并为其他 OAR 提供最佳覆盖。计算并分析了常见的剂量学参数，如 D05、D95 和 D50。使用统计检验将白细胞、中性粒细胞、血小板、肌酐、GFR、血红蛋白、总生存率和移植物抗宿主病与剂量评估相关联。
肺的平均 D95 为 48.23%，不到规定剂量和未降低剂量的一半。胸部的 D95 几乎是其两倍，为 84.95%。整个肝脏覆盖率范围从 D95 的 96.79%到 D05 的 107%。对所有分析患者的平均剂量节省导致右肾的平均 D95 为 68.64%，左肾为 69.31%。脾脏的平均 D95 为 94.28%，D05 为 107.05%。均匀性指数范围从肝脏的 1.12 到肺的 2.28。对这些血液动力学进行的附加显著性分析表明，白细胞计数在 2 戈瑞组和其他三组之间有显著差异。进一步对剂量组进行统计学比较，发现没有显著差异。然而，在给予剂量节省（如肺与肋骨和肾）时，OAR 规定剂量有显著变化。
使用调强螺旋断层放疗（HT）来传递 TBI 是造血干细胞移植准备的一种可行方法。在肺和肾等辐射敏感器官中，可以实现显著的剂量节省，同时保持良好的整体覆盖质量。外周血动力学支持 HT 的积极影响，其优势强烈鼓励在临床常规中实施。
