Gonadal-sparing total body irradiation with the use of helical tomotherapy for nonmalignant indications.
Gonadal-sparing total body irradiation with the use of helical tomotherapy for nonmalignant indications.
复制标题
通过使用螺旋形式疗法来进行非态度的适应症，可以进行性腺的总体照射。
DOI：
10.5603/rpor.a2021.0006
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发表时间：
2021
期刊：
影响因子：
--
通讯作者：
Robinson TJ
中科院分区：
文献类型：
--
作者：
Dibs K;Sim AJ;Peñagaricano JA;Latifi K;Garcia GA;Peters JA;Nieder ML;Kim S;Robinson TJ
目的是证明保留性腺的全身照射（TBI）与螺旋断层治疗的可行性和技术。全身照射是同种异体干细胞移植前调理方案的常见部分。通常需要屏蔽或减少性腺剂量以保持生育能力，特别是在因非恶性适应症接受移植的年轻患者中。螺旋断层治疗（HT）已被证明在危险器官（OA R）剂量和剂量均匀性方面优于传统的TBI递送。我们提出了两个代表性的病例（一男一女）来说明这种技术的可行性，每个人在同种异体干细胞移植前接受了单一剂量的3Gy，用于良性适应症。计划靶体积（PTV）包括全身减去OA Rs，包括肺、心、脑（各收缩1cm）以及性腺（睾丸扩张5cm，卵巢扩张0.5 cm）。对于男性患者，我们获得的均匀性指数为1.35，睾丸最大和中位计划剂量分别为0.53 Gy和0.35 Gy。体内剂量测定显示实际接受剂量为0.48 Gy。对于女性患者，我们获得了1.13的均匀性指数，卵巢最大和中位计划剂量分别为1.66 Gy和0.86 Gy。保留性腺的创伤性脑损伤是可行的，并且在需要创伤性脑损伤的非恶性疾病患者中使用HT作为干细胞移植前调节方案的一部分。
The aim was to demonstrate the feasibility and technique of gonadal sparing total body irradiation (TBI) with helical tomotherapy. Total body irradiation is a common part of the conditioning regimen prior to allogeneic stem cell transplantation. Shielding or dose-reduction to the gonads is often desired to preserve fertility, particularly in young patients undergoing transplant for non-malignant indications. Helical tomotherapy (HT) has been shown to be superior to traditional TBI delivery for organ at risk (OA R) doses and dose homogeneity. We present two representative cases (one male and one female) to illustrate the feasibility of this technique, each of whom received 3Gy in a single fraction prior to allogeneic stem cell transplant for benign indications. The planning target volume (PTV) included the whole body with a subtraction of OA Rs including the lungs, heart, and brain (each contracted by 1cm) as well as the gonads (testicles expanded by 5 cm and ovaries expanded by 0.5 cm). For the male patient we achieved a homogeneity index of 1.35 with a maximum and median planned dose to the testes of 0.53 Gy and 0.35 Gy, respectively. In-vivo dosimetry demonstrated an actual received dose of 0.48 Gy. For the female patient we achieved a homogeneity index of 1.13 with a maximum and median planned dose to the ovaries of 1.66 Gy and 0.86 Gy, respectively. Gonadal sparing TBI is feasible and deliverable using HT in patients with non-malignant diseases requiring TBI as part of a pre-stem cell transplant conditioning regimen.