Feasibility of a novel dose fractionation strategy in TMI/TMLI
Feasibility of a novel dose fractionation strategy in TMI/TMLI
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DOI：
10.1186/s13014-018-1201-0
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发表时间：
2018-12-17
影响因子：
3.6
通讯作者：
Liu, Hui
中科院分区：
文献类型：
--
作者：
Bao, Zhirong;Zhao, Hongli;Liu, Hui
BackgroundTo报告我们的经验，计划和提供全骨髓照射（TMI）和全骨髓和淋巴照射（TMLI）的血液系统malignances.Methods27例接受骨髓移植的患者进行了治疗与TMI/TMLI使用螺旋断层治疗（HT）。下颌骨的所有骨骼排除包括治疗靶体积，对于TMLI，根据临床适应症，还包括淋巴结链、肝脏、脾脏和/或大脑。TMI的计划剂量为8 Gy，分2次，1天内输送，而TMLI的计划剂量为10 Gy，分2次，BID。风险器官（OAR）轮廓包括大脑、脑干、透镜、眼睛、视神经、腮腺、口腔、肺、心脏、肝脏、肾脏、胃、小肠、膀胱和直肠。特别地，在重叠区域实施了避免热或冷剂量的简单方法，并采用计划和来评估剂量不均匀性。此外，从54个治疗的设置错误进行了总结，以衡量immobilization.ResultsDuring的TMI/TMLI治疗的有效性，没有急性不良反应发生在放射治疗。两名患者在放疗后立即出现恶心或呕吐。对于9例接受TMI治疗的患者，主要器官的中位剂量减少为处方剂量的30-65%，远低于传统的全身照射（TBI）。同时，8 Gy/2F TMI入路的OAR平均生物等效剂量与常规12 Gy/6 F TMI入路无差异。在剂量交界区，93%的PTV被规定剂量覆盖，无明显热点。对于27例患者，整体设置校正低于3 mm，除了那些在SI方向上的骨盆区域，表现出良好的immobilation.ConclusionThe本研究证实了HT为基础的TMI/TMLI提供8- 10 Gy在2个分数超过1天的技术可行性。对于接受造血细胞移植的患者，建议的8 Gy/2F TMI（或10 Gy/2F TMLI）策略可能是一种新的方法，以提高输送效率，增加靶区的有效辐射剂量，同时保持严重器官毒性的低风险。
BackgroundTo report our experience in planning and delivering total marrow irradiation (TMI) and total marrow and lymphatic irradiation (TMLI) in patients with hematologic malignancies.MethodsTwenty-seven patients undergoing bone marrow transplantation were treated with TMI/TMLI using Helical Tomotherapy (HT). All skeletal bones exclusion of the mandible comprised the treatment target volume and, for TMLI, lymph node chains, liver, spleen and/or brain were also included according to the clinical indication. Planned dose of 8Gy in 2 fractions was delivered over 1 day for TMI while 10Gy in 2 fractions BID was used for TMLI. Organs at risk (OAR) contoured included the brain, brainstem, lens, eyes, optic nerves, parotids, oral cavity, lungs, heart, liver, kidneys, stomach, small bowel, bladder and rectum. In particular, a simple method to avoid hot or cold doses in the overlapping region was implemented and the plan sum was adopted to evaluate dose inhomogeneity. Furthermore, setup errors from 54 treatments were summarized to gauge the effectiveness of immobilization.ResultsDuring the TMI/TMLI treatment, no acute adverse effects occurred during the radiation treatment. Two patients suffered nausea or vomiting right after radiation course. For the 9 patients treated with TMI, the median dose reduction of major organs varied 30-65% of the prescribed dose, substantially lower than the traditional total body irradiation (TBI). Meanwhile, average biological equivalent doses to OARs with 8Gy/2F TMI approach were not different from the conventional 12Gy/6F TMI approach. In the dose junction region, the 93% of PTV was covered by the prescribed dose without obvious hotspots. For the 27 patients, the overall setup corrections were lower than 3mm except those in the SI direction for abdomen-pelvis region, demonstrating excellent immobilization.ConclusionThe present study confirmed the technical feasibility of HT-based TMI/TMLI delivering 8-10Gy in 2 fractions over 1 day. For patients undergoing hematopoietic cell transplantation the proposed 8Gy/2F TMI (or 10Gy/2F TMLI) strategy may be a novel approach to improve delivery efficiency, increase effective radiation dose to target while maintaining low risk of severe organ toxicities.