Dose distribution homogeneity in two TBI techniques-Analysis of 208 irradiated patients conducted in Stanislaw Leszczynski Memorial Hospital, Katowice

Dosimetric comparison of AP/PA and bilateral geometries for total body irradiation treatment

Total body irradiation (TBI) is an external radiotherapy technique. Its aim is to deliver a therapeutic dose uniformly within ± 10% of the absorbed dose to the prescription point. In the present study, the TBI technique was implemented in anterior/posterior (AP/PA), and bilateral geometry with photons from a 6 [Formula: see text] and 18 [Formula: see text] accelerator. The TBI technique was implemented on an Alderson Rando phantom at 312 [Formula: see text] source surface distance. During bilateral fraction, rice bags were applied as tissue compensators. To reduce the lung's absorbed dose to the acceptance level, in AP/PA geometry lung blocks made of Cerrobend were used. The required monitor unit (MU) for each fraction was calculated regarding depending on the prescribed dose and beam output. Gafchromic EBT₃ films were used for dosimetry between the phantom layers in eight selected points. It is demonstrated that dose uniformity for AP/PA geometry with 6 [Formula: see text] and 18 [Formula: see text] photons was within ± 10%. In contrast, for the bilateral geometry the dose uniformity was not acceptable for both studied energies; However, the results for 18 [Formula: see text] were better than those for 6 [Formula: see text]. Dose accuracy for all measurements was within ± 5 of the prescribed dose. The absorbed dose to the lungs was successfully reduced using the lung blocks. By combining different therapeutic geometries and energies over six fractions, the results of uniformity and accuracy of dose delivery could be improved. It is concluded that the introduced TBI method achieved good dose accuracy and acceptable dose uniformity. Lungs absorbed dose was lower than 10 [Formula: see text] using the lungs blocks. Based on these results, the TBI technique can now be implemented in radiotherapy at Tehran's Imam Hospital. The approach developed in the present study can be used and adapted to match with the conditions at other hospitals.

Comparison of different TBI techniques in terms of dose homogeneity - review study

Total body irradiation (TBI) is a kind of external beam radiotherapy, used in conjunction with chemotherapy with the purpose of immunosuppression. Since the target in TBI is the whole body, so achieving uniform dose distribution throughout the entire body during TBI is necessary. As recommended by AAPM dose variation must be within ±10% of the prescription dose. With the evidences from literature there is limited substantiation to consider a treatment method better than others, but with regard to the size of the treatment room, workload of the radiotherapy department and prevalent technology used within each treatment department it is recommended to make the suitable and optimum method in each department. In this work, a review study was performed on different TBI techniques with the purpose of assessment and comparison of dose distribution homogeneity in these methods.

The safety and efficacy of a novel hypo-fractionated total marrow and lymphoid irradiation before allogeneic stem cell transplantation for lymphoma and acute leukemia

Purpose

Total body irradiation (TBI) has been widely utilized as part of the conditioning regimen for hematopoietic stem cell transplantation (HSCT), but is associated with significant toxicities. Targeted TBI using helical Tomotherapy allows precise and homogeneous tumor coverage and excellent sparing of organs at risk. The purpose of this study was to evaluate the clinical outcomes of a novel hypo-fractionation strategy for patients receiving total marrow and involved lymphoid irradiation (TMLI) as part of the conditioning regimen before HSCT.

Methods and Materials

61 patients (7 acute myelogenous leukemia (AML), 33 acute lymphoblastic leukemia (ALL), 18 non-Hodgkin's lymphoma (NHL), 3 mixed acute leukemia (MAL)) received conditioning radiation treatment with TMLI (8 Gy to bone marrow, 10 Gy to involved field in 2 fractions per day) in conjunction with chemotherapy before transplantation.

Results

The median age of 61 patients with TMLI was 24 (4-54) years. The prescribed dose covered the entire bone and involved target volume, and the dose of organs at risk (OAR) was reduced by 28%-78% of the prescription dose. Grade 1-2 nausea and vomiting occurred in 12 patients and grade 1-2 pain in 6 patients during radiotherapy. Fatigue occurred in 16 patients. 2 patients had diarrhea, enteritis, and 1 patient had fever. None of patient had grade 3-4 non-hematologic adverse reactions. Late (30 days after HSCT) grade 2 toxicities including reversible enteritis occurred in 3 patients. 5 patients developed infectious pneumonia. The 2 years progression-free survival (PFS) was 64.1% (95% CI: 0.16-0.22) and overall survival (OS) was 74.7% (95% CI: 0.19-0.24) for the 61 patients who had received their planned HSCT. The 2-year non-relapse mortality was significantly reduced to 5% in this patient cohort.

Conclusions

This study demonstrates that hypo-fractionated TMLI (8 Gy to bone marrow, 10 Gy to involved field in a single day) as a conditioning regimen for lymphoma and acute leukemia was feasible and the clinical outcomes were acceptable.

Total body irradiation with volumetric modulated arc therapy: Dosimetric data and first clinical experience

BACKGROUND

To implement total body irradiation (TBI) using volumetric modulated arc therapy (VMAT). We applied the Varian RapidArc™ software to calculate and optimize the dose distribution. Emphasis was placed on applying a homogenous dose to the PTV and on reducing the dose to the lungs.

METHODS

From July 2013 to July 2014 seven patients with leukaemia were planned and treated with a VMAT-based TBI-technique with photon energy of 6 MV. The overall planning target volume (PTV), comprising the whole body, had to be split into 8 segments with a subsequent multi-isocentric planning. In a first step a dose optimization of each single segment was performed. In a second step all these elements were calculated in one overall dose-plan, considering particular constraints and weighting factors, to achieve the final total body dose distribution. The quality assurance comprised the verification of the irradiation plans via ArcCheck™ (Sun Nuclear), followed by in vivo dosimetry via dosimeters (MOSFETs) on the patient.

RESULTS

The time requirements for treatment planning were high: contouring took 5-6 h, optimization and dose calculation 25-30 h and quality assurance 6-8 h. The couch-time per fraction was 2 h on day one, decreasing to around 1.5 h for the following fractions, including patient information, time for arc positioning, patient positioning verification, mounting of the MOSFETs and irradiation. The mean lung dose was decreased to at least 80 % of the planned total body dose and in the central parts to 50 %. In two cases we additionally pursued a dose reduction of 30 to 50 % in a pre-irradiated brain and in renal insufficiency. All high dose areas were outside the lungs and other OARs. The planned dose was in line with the measured dose via MOSFETs: in the axilla the mean difference between calculated and measured dose was 3.6 % (range 1.1-6.8 %), and for the wrist/hip-inguinal region it was 4.3 % (range 1.1-8.1 %).

CONCLUSION

TBI with VMAT provides the benefit of satisfactory dose distribution within the PTV, while selectively reducing the dose to the lungs and, if necessary, in other organs. Planning time, however, is extensive.

Experimental set up for the irradiation of biological samples and nuclear track detectors with UV C

AIM

In this work we present a methodology to produce an "imprint" of cells cultivated on a polycarbonate detector by exposure of the detector to UV C radiation.

BACKGROUND

The distribution and concentration of (10)B atoms in tissue samples coming from BNCT (Boron Neutron Capture Therapy) protocols can be determined through the quantification and analysis of the tracks forming its autoradiography image on a nuclear track detector. The location of boron atoms in the cell structure could be known more accurately by the simultaneous observation of the nuclear tracks and the sample image on the detector.

MATERIALS AND METHODS

A UV C irradiator was constructed. The irradiance was measured along the lamp direction and at different distances. Melanoma cells were cultured on polycarbonate foils, incubated with borophenylalanine, irradiated with thermal neutrons and exposed to UV C radiation. The samples were chemically attacked with a KOH solution.

RESULTS

A uniform irradiation field was established to expose the detector foils to UV C light. Cells could be seeded on the polycarbonate surface. Both imprints from cells and nuclear tracks were obtained after chemical etching.

CONCLUSIONS

It is possible to yield cellular imprints in polycarbonate. The nuclear tracks were mostly present inside the cells, indicating a preferential boron uptake.