Hostname: page-component-586b7cd67f-dsjbd Total loading time: 0 Render date: 2024-11-28T22:09:15.634Z Has data issue: false hasContentIssue false
  • English
  • Français

Pulmonary toxicity following total body irradiation for acute lymphoblastic leukaemia: The Ottawa Hospital Cancer Centre (TOHCC) experience

Published online by Cambridge University Press:  02 November 2015

R. K. Ujaimi ,
N. Isfahanian ,
D. J. La Russa ,
R. Samant ,
C. Bredeson  and
P. Genest
R. K. Ujaimi*
Affiliation:
The Radiation Medicine Program, The Ottawa Hospital Cancer Centre, Ottawa, ON, Canada King Abdulaziz University, Jeddah, Saudi Arabia
N. Isfahanian
Affiliation:
The Radiation Medicine Program, The Ottawa Hospital Cancer Centre, Ottawa, ON, Canada
D. J. La Russa
Affiliation:
The Radiation Medicine Program, The Ottawa Hospital Cancer Centre, Ottawa, ON, Canada
R. Samant
Affiliation:
The Radiation Medicine Program, The Ottawa Hospital Cancer Centre, Ottawa, ON, Canada
C. Bredeson
Affiliation:
Blood and Bone Marrow Transplant Program, The Ottawa Hospital, Ottawa, ON, Canada
P. Genest
Affiliation:
The Radiation Medicine Program, The Ottawa Hospital Cancer Centre, Ottawa, ON, Canada
*
Correspondence to: Dr Reem Ujaimi, Faculty of Medicine, Division of Radiation Oncology, University of Ottawa, Ed Smyth Road, Ottawa, ON, K1H 8L6 Canada. Tel: 613-737-7700, ext. 70196; Fax: 613-247-3511; E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Purpose

To review the incidence of clinically significant pulmonary toxicity following total body irradiation (TBI) as a part of the conditioning regimen for acute lymphoblastic leukaemia (ALL) patients undergoing bone marrow transplantation (BMT) at The Ottawa Hospital Cancer Centre.

Methods

This is a retrospective review of ALL patients who received TBI in The Ottawa Hospital Bone Marrow Transplant Program (TOH-BMT) as part of their conditioning regimen from 1991 to 2011 inclusive. The patients were treated using a locally developed translating-couch irradiation technique. We have analysed all available data for the first 100 days following TBI to determine the incidence of radiation-induced pulmonary toxicities.

Results

Of the total 622 patients undergoing TBI during the specified period, 88 had ALL. Median age at BMT was 30 years and the conditioning regimens varied. A total of 74 (84%) patients received 12 Gy/6 F/BID of TBI. A total of 55 (63%) patients have died, 32 (36%) within the 1st year after BMT. In the 1st year, pulmonary events were reported for 24 (27%) patients, and the follow-up notes were unavailable for seven (8%). Pulmonary toxicities were reported as the cause of death for six patients, five (6%) within the 1st year. It is estimated that the total number of deaths in the 1st year possibly attributed to radiation-induced lung injury was four (4·5%). Eight (9%) patients had symptoms suggestive of non-lethal grade 2–3 radiation-induced pneumonitis.

Conclusions

TBI continues to be an important component of the conditioning regimen for ALL patients undergoing BMT, and the incidence of radiation-induced pulmonary injury, using our technique and lung dose, is comparable to the published literature.

Keywords

ALLpulmonary toxicitytranslated bed techniqueTBI
Type
Original Articles
Information
Journal of Radiotherapy in Practice , Volume 15 , Issue 1 , March 2016 , pp. 54 - 60
Check for updates
Copyright
© Cambridge University Press 2015 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Gupta, V, Lazarus, HM, Keating, A. Myeloablative conditioning regimens for AML allografts: 30 years later. Bone Marrow Transplant 2003; 32 (10): 969–978.CrossRefGoogle ScholarPubMed
2.Hill-Kayser, CE, Plastaras, JP, Tochner, Z, Glatstein, E. TBI during BM and SCT: review of the past, discussion of the present and consideration of future directions. Bone Marrow Transplant 2011; 46 (4): 475–484.CrossRefGoogle ScholarPubMed
3.Jahnke, A, Jahnke, L, Molina-Duran, Fet al. Arc therapy for total body irradiation--a robust novel treatment technique for standard treatment rooms. Radiother Oncol 2014; 110 (3): 553–557.CrossRefGoogle ScholarPubMed
4.Kirby, N, Held, M, Morin, O, Fogh, S, Pouliot, J. Inverse-planned modulated-arc total-body irradiation. Med Phys 2012; 39 (5): 2761–2764.CrossRefGoogle ScholarPubMed
5.Clift, RA, Buckner, CD, Appelbaum, FRet al. Allogeneic marrow transplantation in patients with acute myeloid leukemia in first remission: a randomized trial of two irradiation regimens. Blood 1990; 76 (9): 1867–1871.CrossRefGoogle ScholarPubMed
6.McAfee, SL, Powell, SN, Colby, C, Spitzer, TR. Dose-escalated total body irradiation and autologous stem cell transplantation for refractory hematologic malignancy. Int J Radiat Oncol Biol Phys 2002; 53 (1): 151–156.CrossRefGoogle ScholarPubMed
7.Sobecks, RM, Daugherty, CK, Hallahan, DE, Laport, GF, Wagner, ND, Larson, RA. A dose escalation study of total body irradiation followed by high-dose etoposide and allogeneic blood stem cell transplantation for the treatment of advanced hematologic malignancies. Bone Marrow Transplant 2000; 25 (8): 807–813.CrossRefGoogle ScholarPubMed
8.Hui, SK, Kapatoes, J, Fowler, Jet al. Feasibility study of helical tomotherapy for total body or total marrow irradiation. Med Phys 2005; 32 (10): 3214–3224.CrossRefGoogle ScholarPubMed
9.Wong, JY, Liu, A, Schultheiss, Tet al. Targeted total marrow irradiation using three-dimensional image-guided tomographic intensity-modulated radiation therapy: an alternative to standard total body irradiation. Biol Blood Marrow Transplant 2006; 12 (3): 306–315.CrossRefGoogle ScholarPubMed
10.Quast, U. Total body irradiation--review of treatment techniques in Europe. Radiother Oncol 1987; 9 (2): 91106.CrossRefGoogle ScholarPubMed
11.Quast, U. Physical treatment planning of total-body irradiation: patient translation and beam-zone method. Med Phys 1985; 12 (5): 567–574.CrossRefGoogle ScholarPubMed
12.Connors, S, Scrimger, J, Logus, W, Johnson, L, Schartner, E. Development of a translating bed for total body irradiation. Med Dosim 1988; 13 (4): 195–199.CrossRefGoogle ScholarPubMed
13.Hussain, A, Villarreal-Barajas, JE, Dunscombe, P, Brown, DW. Aperture modulated, translating bed total body irradiation. Med Phys 2011; 38 (2): 932–941.CrossRefGoogle ScholarPubMed
14.Sarfaraz, M, Yu, C, Chen, DJ, Der, L. A translational couch technique for total body irradiation. J Appl Clin Med Phys 2001; 2 (4): 201–209.CrossRefGoogle ScholarPubMed
15.Gerig, LH, Szanto, J, Bichay, T, Genest, P. A translating-bed technique for total-body irradiation. Phys Med Biol 1994; 39 (1): 19–35.CrossRefGoogle ScholarPubMed
16.Barrett, A. Total body irradiation (TBI) before bone marrow transplantation in leukaemia: a co-operative study from the European Group for Bone Marrow Transplantation. Br J Radiol 1982; 55 (656): 562–567.CrossRefGoogle Scholar
17.Ettinger, NA, Trulock, EP. Pulmonary considerations of organ transplantation. Part 2. Am Rev Respir Dis. 1991; 144 (1): 213–223.CrossRefGoogle ScholarPubMed