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Köksal M, Baumert J, Jazmati D, Schoroth F, Garbe S, Koch D, Scafa D, Sarria GR, Leitzen C, Massoth G, Delis A, Heine A, Holderried T, Brossart P, Müdder T, Schmeel LC. Whole body irradiation with intensity-modulated helical tomotherapy prior to haematopoietic stem cell transplantation: analysis of organs at risk by dose and its effect on blood kinetics. J Cancer Res Clin Oncol 2023; 149:7007-7015. [PMID: 36856852 PMCID: PMC10374741 DOI: 10.1007/s00432-023-04657-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 02/15/2023] [Indexed: 03/02/2023]
Abstract
BACKGROUND 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. PATIENTS AND METHODS 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. RESULTS 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). CONCLUSION 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.
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Affiliation(s)
- Mümtaz Köksal
- Radiation Oncology, University Hospital Bonn, Bonn, Germany.
| | | | - Danny Jazmati
- Radiation Oncology, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Felix Schoroth
- Radiation Oncology, University Hospital Bonn, Bonn, Germany
| | - Stephan Garbe
- Radiation Oncology, University Hospital Bonn, Bonn, Germany
| | - David Koch
- Radiation Oncology, University Hospital Bonn, Bonn, Germany
| | - Davide Scafa
- Radiation Oncology, University Hospital Bonn, Bonn, Germany
| | | | | | - Gregor Massoth
- Anaesthesiology, Perioperative and Pain Medicine, University Hospital Bonn, Bonn, Germany
| | - Achilles Delis
- Anaesthesiology, Perioperative and Pain Medicine, University Hospital Bonn, Bonn, Germany
| | - Annkristin Heine
- Internal Medicine-Oncology, Haematology and Rheumatology, University Hospital Bonn, Bonn, Germany
| | - Tobias Holderried
- Internal Medicine-Oncology, Haematology and Rheumatology, University Hospital Bonn, Bonn, Germany
| | - Peter Brossart
- Internal Medicine-Oncology, Haematology and Rheumatology, University Hospital Bonn, Bonn, Germany
| | - Thomas Müdder
- Radiation Oncology, University Hospital Bonn, Bonn, Germany
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