ESTRO ACROP and SIOPE recommendations for myeloablative total body irradiation in children
Hoeben, Bianca A W; Pazos, Montserrat; Seravalli, Enrica; Bosman, Mirjam E; Losert, Christoph; Albert, Michael H; Boterberg, Tom; Ospovat, Inna; Mico Milla, Soraya; Abakay, Candan Demiroz; Engellau, Jacob; Johansson, Vilberg; Kos, Gregor; Supiot, Stéphane; Llagostera, Camille; Bierings, Marc; Scarzello, Giovanni; Seiersen, Klaus; Smith, Ed; Ocanto, Abrahams; Ferrer, Carlos; Bentzen, Søren M; Kobyzeva, Daria A; Loginova, Anna A; Janssens, Geert O
(2022) Radiotherapy & Oncology, volume 173, pp. 119 - 133
(Article)
Abstract
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
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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.
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Keywords: Consensus recommendations, Hematopoietic stem cell transplantation, Pediatric, Total Body Irradiation, Hematology, Oncology, Radiology Nuclear Medicine and imaging, Journal Article
ISSN: 0167-8140
Publisher: Elsevier Ireland Ltd
Note: Funding Information: We thank the following reviewers for their thorough evaluation of this manuscript: Prof. dr. Lena Specht, Rigshospitalet/Copenhagen University hospital, Copenhagen, Denmark; Dr. Henry Mandeville, Department of Radiotherapy, The Royal Marsden Hospital, Sutton, United Kingdom; Prof. dr. Claus Belka, University Hospital, LMU Munich, Germany; Dr. Nuria Jornet, Hospital de la Santa Creu i Sant Pau: Barcelona, Catalunya, Spain; Prof. dr. Andrea Filippi, Radiation Oncology Department, Fondazione IRCCS Policlinico S. Matteo and University of Pavia, Italy. There are no conflicts of interest to declare. Publisher Copyright: © 2022 The Author(s)
(Peer reviewed)