ESTRO ACROP and SIOPE recommendations for myeloablative Total Body Irradiation in children.

Autor: Hoeben BAW; Dept. of Radiation Oncology, University Medical Center Utrecht, The Netherlands; Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands. Electronic address: b.a.w.hoeben@umcutrecht.nl., Pazos M; Dept. of Radiation Oncology, University Hospital, LMU Munich, Germany., Seravalli E; Dept. of Radiation Oncology, University Medical Center Utrecht, The Netherlands., Bosman ME; Dept. of Radiation Oncology, University Medical Center Utrecht, The Netherlands., Losert C; Dept. of Radiation Oncology, University Hospital, LMU Munich, Germany., Albert MH; Dept. of Pediatrics, Dr. von Hauner Children's Hospital, University Hospital, LMU Munich, Germany., Boterberg T; Dept. of Radiation Oncology, Ghent University Hospital, Ghent, Belgium., Ospovat I; Dept. of Radiation Oncology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel., Mico Milla S; Dept. of Radiation Oncology, Vall d'Hebron University Hospital, Barcelona, Spain., Demiroz Abakay C; Dept. of Radiation Oncology, Uludag University Faculty of Medicine Hospital, Bursa, Turkey., Engellau J; Dept. of Radiation Oncology, Skåne University Hospital, Lund, Sweden., Jóhannesson V; Dept. of Radiation Oncology, Skåne University Hospital, Lund, Sweden., Kos G; Dept. of Radiation Oncology, Institute of Oncology Ljubljana, Slovenia., Supiot S; Dept. of Radiation Oncology, Institut de Cancérologie de l'Ouest, Nantes St. Herblain, France., Llagostera C; Dept. of Medical Physics, Institut de Cancérologie de l'Ouest, Nantes St. Herblain, France., Bierings M; Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands., Scarzello G; Dept. of Radiation Oncology, Veneto Institute of Oncology-IRCCS, Padua, Italy., Seiersen K; Danish Centre for Particle Therapy, Aarhus, Denmark., Smith E; Dept. of Radiation Oncology, The Christie NHS Foundation Trust, Manchester, United Kingdom., Ocanto A; Dept. of Radiation Oncology, La Paz University Hospital, Madrid, Spain., Ferrer C; Dept. of Medical Physics and Radiation Protection, La Paz University Hospital, Madrid, Spain., Bentzen SM; Dept. of Epidemiology and Public Health, Division of Biostatistics and Bioinformatics, University of Maryland School of Medicine, Baltimore, United States., Kobyzeva DA; Dept. of Radiation Oncology, Dmitry Rogachev National Research Center of Pediatric Hematology, Oncology and Immunology, Moscow, Russia., Loginova AA; Dept. of Radiation Oncology, Dmitry Rogachev National Research Center of Pediatric Hematology, Oncology and Immunology, Moscow, Russia., Janssens GO; Dept. of Radiation Oncology, University Medical Center Utrecht, The Netherlands; Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands.
Jazyk: angličtina
Zdroj: Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology [Radiother Oncol] 2022 Aug; Vol. 173, pp. 119-133. Date of Electronic Publication: 2022 May 31.
DOI: 10.1016/j.radonc.2022.05.027
Abstrakt: Background and Purpose: Myeloablative Total Body Irradiation (TBI) is an important modality in conditioning for allogeneic hematopoietic stem cell transplantation (HSCT), especially in children with high-risk acute lymphoblastic leukemia (ALL). TBI practices are heterogeneous and institution-specific. Since TBI is associated with multiple late adverse effects, recommendations may help to standardize practices and improve the outcome versus toxicity ratio for children.
Material and Methods: The European Society for Paediatric Oncology (SIOPE) Radiotherapy TBI Working Group together with ESTRO experts conducted a literature search and evaluation regarding myeloablative TBI techniques and toxicities in children. Findings were discussed in bimonthly virtual meetings and consensus recommendations were established.
Results: Myeloablative TBI in HSCT conditioning is mostly performed for high-risk ALL patients or patients with recurring hematologic malignancies. TBI is discouraged in children <3-4 years old because of increased toxicity risk. Publications regarding TBI are mostly retrospective studies with level III-IV evidence. Preferential TBI dose in children is 12-14.4 Gy in 1.6-2 Gy fractions b.i.d. Dose reduction should be considered for the lungs to <8 Gy, for the kidneys to ≤10 Gy, and for the lenses to <12 Gy, for dose rates ≥6 cGy/min. Highly conformal techniques i.e. TomoTherapy and VMAT TBI or Total Marrow (and/or Lymphoid) Irradiation as implemented in several centers, improve dose homogeneity and organ sparing, and should be evaluated in studies.
Conclusions: These ESTRO ACROP SIOPE recommendations provide expert consensus for conventional and highly conformal myeloablative TBI in children, as well as a supporting literature overview of TBI techniques and toxicities.
(Copyright © 2022 The Author(s). Published by Elsevier B.V. All rights reserved.)
Databáze: MEDLINE
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