Vol 26, No 4 (2021)
Research paper
Published online: 2021-03-26

open access

Page views 1189
Article views/downloads 603
Get Citation

Connect on Social Media

Connect on Social Media

Evaluation of volumetric modulated arc therapy (VMAT) — based total body irradiation (TBI) in pediatric patients

Kadir Yaray1, Edrine Damulira1
Rep Pract Oncol Radiother 2021;26(4):518-527.

Abstract

BACKGROUND: The dosimetric characterization of volumetric modulated arc therapy (VMAT)-based total-body irradiation (TBI) in pediatric patients is evaluated.

MATERIALS AND METHODS: Twenty-two patients between the ages of 2 and 12 years were enrolled for VMAT-based TBI from 2018 to 2020. Three isocenters were irradiated over three overlapping arcs. While prescribing 90% of the TBI dose to the planning treatment volume (PTV), two fractions (2 Gy each) were delivered each day; hence 12 Gy was delivered in six fractions. During treatment optimization, the mean lung and kidney doses were set not to exceed 7 Gy and 7.5 Gy, respectively. The maximum lens dose was also set to less than 4 Gy. Patient quality assurance was carried out by comparing treatment planning system doses to the 3-dimensional measured doses by the ArcCHECK® detector. The electronic portal imaging device (EPID) gamma indices were also obtained.

RESULTS: The average mean lung dose was 7.75 ± 0.18 Gy, mean kidney dose 7.63 ± 0.26 Gy, maximum lens dose 4.41 ± 0.39 Gy, and the mean PTV dose 12.69 ± 0.16 Gy. The average PTV heterogeneity index was 1.15 ± 0.03. Average differences in mean kidney dose, mean lung dose, and mean target dose were 2.79% ± 0.88, 0.84% ± 0.45 and 0.93% ± 0.47, respectively; when comparing planned and ArcCHECK® measured doses. Only Grade 1-2 radiation toxicities were recorded, based on CTCAE v5.0 scoring criteria.

CONCLUSIONS: VMAT-TBI was characterized with good PTV coverage, homogeneous dose distribution, planned and measured dose agreement, and low toxicity.

Article available in PDF format

View PDF Download PDF file

References

  1. Wong JY, Hui SK. Total Marrow Irradiation. Springer, London 2020.
  2. Wong JYC, Filippi AR, Dabaja BS, et al. Total Body Irradiation: Guidelines from the International Lymphoma Radiation Oncology Group (ILROG). Int J Radiat Oncol Biol Phys. 2018; 101(3): 521–529.
  3. Springer A, Hammer J, Winkler E, et al. Total body irradiation with volumetric modulated arc therapy: Dosimetric data and first clinical experience. Radiat Oncol. 2016; 11: 46.
  4. Mohty M, Malard F, Savani BN, et al. High-dose total body irradiation and myeloablative conditioning before allogeneic hematopoietic cell transplantation: time to rethink? Biol Blood Marrow Transplant. 2015; 21(4): 620–624.
  5. Hong S, Barker C, Klein JP, et al. Trends in Utilization of Total Body Irradiation (TBI) Prior to Hematopoietic Cell Transplantation (HCT) Worldwide. Biol Blood Marrow Transpl. 2012; 18(2): S336–S337.
  6. Linsenmeier L, Thoennessen D, Negretti L. Total body irradiation (TBI) in pediatric patients. A single-center experience after 30 years of low-dose rate irradiation. Strahlentherapie und Onkol. 2010; 186(11): 614–620.
  7. Bölling T, Kreuziger DC, Ernst I, et al. Retrospective, monocentric analysis of late effects after Total Body Irradiation (TBI) in adults. Strahlenther Onkol. 2011; 187(5): 311–315.
  8. Tas B, Durmus IF, Okumus A, et al. Total-body irradiation using linac-based volumetric modulated arc therapy: Its clinical accuracy, feasibility and reliability. Radiother Oncol. 2018; 129(3): 527–533.
  9. Symons K, Morrison C, Parry J, et al. Volumetric modulated arc therapy for total body irradiation: A feasibility study using Pinnacle treatment planning system and Elekta Agility™ linac. J Appl Clin Med Phys. 2018; 19(2): 103–110.
  10. Blomain ES, Kovalchuk N, Neilsen BK, et al. A Preliminary Report of Gonadal-Sparing TBI Using a VMAT Technique. Pract Radiat Oncol. 2021; 11(2): e134–e138.
  11. Gruen A, Ebell W, Wlodarczyk W, et al. Total Body Irradiation (TBI) using Helical Tomotherapy in children and young adults undergoing stem cell transplantation. Radiat Oncol. 2013; 8: 92.
  12. Ricardi U, Filippi AR, Biasin E, et al. Late toxicity in children undergoing hematopoietic stem cell transplantation with TBI-containing conditioning regimens for hematological malignancies. Strahlenther Onkol. 2009; 185 Suppl 2: 17–20.
  13. Ouyang L, Folkerts M, Zhang Y, et al. Volumetric modulated arc therapy based total body irradiation: Workflow and clinical experience with an indexed rotational immobilization system. Phys Imag Radiat Oncol. 2017; 4: 22–25.
  14. Losert C, Shpani R, Kießling R, et al. Novel rotatable tabletop for total-body irradiation using a linac-based VMAT technique. Radiat Oncol. 2019; 14(1): 244.
  15. Council R. Health risks from exposure to low levels of ionizing radiation: BEIR VII phase 2. Vol. 7. National Academies Press, Washington 2006.
  16. Achari R, Das A, Mahata A. Total Body Irradiation in Stem Cell Transplant. Contemp Bone Marrow Transplant. 2020: 1–18.
  17. Kataria T, Sharma K, Subramani V, et al. Homogeneity Index: An objective tool for assessment of conformal radiation treatments. J Med Phys. 2012; 37(4): 207–213.
  18. Gong Y, Wang J, Bai S, et al. Conventionally-fractionated image-guided intensity modulated radiotherapy (IG-IMRT): a safe and effective treatment for cancer spinal metastasis. Radiat Oncol. 2008; 3: 11.
  19. Zhuang AH, Liu An, Schultheiss TE, et al. Dosimetric study and verification of total body irradiation using helical tomotherapy and its comparison to extended SSD technique. Med Dosim. 2010; 35(4): 243–249.
  20. Grządziel A, Smolińska B, Rutkowski R, et al. EPID dosimetry — configuration and pre-treatment IMRT verification. Rep Pract Oncol Radiother. 2007; 12(6): 307–312.
  21. Low DA, Harms WB, Mutic S, et al. A technique for the quantitative evaluation of dose distributions. Med Phys. 1998; 25(5): 656–661.
  22. Keane TJ, Dyk Jv, Rider WD. Idiopathic interstitial pneumonia following bone marrow transplantation: The relationship with total body irradiation. Int J Radiat Oncol Biol Phys. 1981; 7(10): 1365–1370.
  23. Ishida Y, Sakamoto N, Kamibeppu K, et al. Late effects and quality of life of childhood cancer survivors: Part 2. Impact of radiotherapy. Int J Hematol. 2010; 92(1): 95–104.



Reports of Practical Oncology and Radiotherapy