Towards homogenization of total body irradiation practices in pediatric patients across SIOPE affiliated centers. A survey by the SIOPE radiation oncology working group
Hoeben, Bianca A W; Pazos, Montserrat; Albert, Michael H; Seravalli, Enrica; Bosman, Mirjam E; Losert, Christoph; Boterberg, Tom; Manapov, Farkhad; Ospovat, Inna; Milla, Soraya Mico; Abakay, Candan Demiroz; Engellau, Jacob; Kos, Gregor; Supiot, Stéphane; Bierings, Marc; Janssens, Geert
(2021) Radiotherapy & Oncology, volume 155, pp. 113 - 119
(Article)
Abstract
BACKGROUND AND PURPOSE: To reduce relapse risk, Total Body Irradiation (TBI) is part of conditioning regimens for hematopoietic stem cell transplantation (HSCT) in pediatric acute leukemia. The study purpose was to evaluate clinical practices regarding TBI, such as fractionation, organ shielding and delivery techniques, among SIOPE affiliated radiotherapy centers. METHODS:
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An electronic survey was sent out to 233 SIOPE affiliated centers, containing 57 questions about clinical practice of TBI. Surveys could be answered anonymously. RESULTS: From over 25 countries, 82 responses were collected. For TBI-performing centers, 40/48 irradiated ≤10 pediatric patients annually (range: 1-2 to >25). Most indications concerned acute lymphoblastic leukemia (ALL) or acute myeloid leukemia (AML). Four different fractionation schedules were used, of which 12 Gy in 6 fractions was applied in 91% for ALL and 86% for AML. Dose reduction to the lungs, mostly to a mean dose of 8-10 Gy, was applied by 28/33 centers for ALL and 19/21 centers for AML, in contrast to much less applied dose reduction to the kidneys (7/33 ALL and 7/21 AML), thyroid (2/33 ALL and 2/21 AML), liver (4/33 ALL and 3/21 AML) and lenses (4/33 ALL and 4/21 AML). Conventional TBI techniques were used by 24/29 responding centers, while 5/29 used advanced optimized planning techniques. CONCLUSION: Across SIOPE, there is a high level of uniformity in fractionation and use of lung shielding. Practices vary regarding other organs-at-risk shielding and implementation of advanced techniques. A SIOPE radiotherapy working group will be established to define international guidelines for pediatric TBI.
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Keywords: Leukemia, Pediatric, Radiotherapy, Stem cell transplantation, TBI, Total body irradiation, Hematology, Oncology, Radiology Nuclear Medicine and imaging, Journal Article
ISSN: 0167-8140
Publisher: Elsevier Ireland Ltd
Note: Funding Information: The non-anonymous participants from the following pediatric-TBI-performing SIOPE centers are kindly acknowledged:, C. Bueno Serrano, University Hospital Reina Sofia, Córdoba, Spain;, A. Escande, Oscar Lambret Comprehensive Cancer Center, Lille, France;, S. Harrabi, University Hospital Heidelberg, Heidelberg, Germany;, H. Jürgens, Tartu University Hospital, Tartu, Estonia;, S. Kamer, Ege University, Izmir, Turkey;, C. Kerr, Montpellier Cancer Institute, Montpellier, France;, B. Malinova, Motol University Hospital, Prague, Czech Republic;, H. Mandeville, The Royal Marsden Hospital, Sutton, United Kingdom;, V. Martin, Gustave Roussy, Villejuif, France;, C. Marzanna, Maria Skłodowska-Curie Memorial Cancer Center Institute, Warsaw, Poland;, O. Ott, University Clinic Erlangen, Erlangen, Germany;, L. Padovani, Assistance Publique es Hopitaux de Marseille CHU Timone, Marseille, France;, F. Pioli; University Hospital Verona, Verona, Italy;, G. Scarzello, Veneto Institute of Oncology, Padua, Italy;, C. Spatola, AOU Policlinico Universitario di Catania, Italy;, The non-anonymous participants from the following non-pediatric-TBI-performing SIOPE centers are kindly acknowledged:, S. Aytac Arslan, Ankara City Hospital, Ankara, Turkey;, D. Brügge, Kantonsspital Sankt Gallen, Sankt Gallen, Switzerland;, J. Cabrera, University Hospital Badajoz, Badajoz, Spain;, A. Cameron, Bristol Haematology and Oncology Centre, Bristol, United Kingdom;, E. Encheva, University Hospital Saint Marina Varna, Varna, Bulgaria;, C. Fuentesz-Sánchez, Hospital Universitario Candelaria, Santa Cruz de Tenerife, Spain;, B. Forthuber, University Clinic Innsbruck, Austria;, H. Hemmatazad, Inselspital Bern, Bern, Switzerland;, L. Jarusevicius, The Hospital of Lithuanian University of Health Sciences (LSMU) Kauno klinikos, Kaunas, Lithuania;, O. Kizilkaya, Şişli Etfal Government Hospital, Istanbul, Turkey;, K. Lehtiö, Oulu University Hospital, Oulu, Finland;, C. Leitzen, University Clinic Bonn, Bonn, Germany;, V. Lewitzki, University Clinic Wuerzburg, Würzburg, Germany;, P. Meijnders, Iridium, Antwerp, Belgium;, P. Melchior, Saarland University hospital, Homburg, Germany;, E. Ozyar, Acibadem Maslak, Istanbul, Turkey;, A. Safwat, Aarhus University Hospital, Aarhus, Denmark;, D. Stanic, Institute of Oncology and Radiology of Serbia, Belgrade, Serbia;, I. Stojkovski, University Clinic of Radiotherapy and Oncology, Skopje, North Macedonia;, J. Zitterbartová, Masaryk Memorial Cancer Institute, Brno, Czech Republik. We thank other centers for anonymous participation. Nothing to declare. Publisher Copyright: © 2020 The Author(s)
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