Twenty years of experience of a tertiary cancer center in total body irradiation with focus on oncological outcome and secondary malignancies
| Autor: | Sieker, Katharina, Fleischmann, Maximilian, Trommel, Martin, Ramm, Ulla, Licher, Jörg, Bug, Gesine, Martin, Hans, Serve, Hubert, Rödel, Claus, Balermpas, Panagiotis |
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| Přispěvatelé: | University of Zurich, Fleischmann, Maximilian |
| Rok vydání: | 2021 |
| Předmět: |
Transplantation Conditioning
Hematopoietic Stem Cell Transplantation Graft vs Host Disease 610 Medicine & health Neoplasms Second Primary Middle Aged 10044 Clinic for Radiation Oncology Leukemia Myeloid Acute Oncology 2741 Radiology Nuclear Medicine and Imaging Humans 2730 Oncology Radiology Nuclear Medicine and imaging Whole-Body Irradiation Retrospective Studies |
| Zdroj: | Strahlentherapie und Onkologie : Organ der Deutschen Rontgengesellschaft ... [et al]. 198(6) |
| ISSN: | 1439-099X |
| Popis: | Purpose Total body irradiation (TBI) is a common part of the myelo- and immuno-ablative conditioning regimen prior to an allogeneic hematopoietic stem cell transplantation (allo-HSCT). Due to concerns regarding acute and long-term complications, there is currently a decline in otherwise successfully established TBI-based conditioning regimens. Here we present an analysis of patient and treatment data with focus on survival and long-term toxicity. Methods Patients with hematologic diseases who received TBI as part of their conditioning regimen prior to allo-HSCT at Frankfurt University Hospital between 1997 and 2015 were identified and retrospectively analyzed. Results In all, 285 patients with a median age of 45 years were identified. Median radiotherapy dose applied was 10.5 Gy. Overall survival at 1, 2, 5, and 10 years was 72.6, 64.6, 54.4, and 51.6%, respectively. Median follow-up of patients alive was 102 months. The cumulative incidence of secondary malignancies was 12.3% (n = 35), with hematologic malignancies and skin cancer predominating. A TBI dose ≥ 8 Gy resulted in significantly improved event-free (p = 0.030) and overall survival (p = 0.025), whereas a total dose ≤ 8 Gy and acute myeloid leukemia (AML) diagnosis were associated with significantly increased rates of secondary malignancies (p = 0.003, p = 0.048) in univariate analysis. No significant correlation was observed between impaired renal or pulmonary function and TBI dose. Conclusion TBI remains an effective and well-established treatment, associated with distinct late-toxicity. However, in the present study we cannot confirm a dose–response relationship in intermediate dose ranges. Survival, occurrence of secondary malignancies, and late toxicities appear to be subject to substantial confounding in this context. |
| Databáze: | OpenAIRE |
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