Long-term follow up of patients with hematological malignancies treated with total body irradiation using intensity modulated radiation therapy

BACKGROUND: With the advent of modern radiation treatment technologies such as intensity modulated radiation therapy (IMRT), there has been increasing interest in its use for total body irradiation (TBI) conditioning regimens for hematopoietic cell transplantation (HCT) to achieve lower doses to cri...

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Autores principales: Ladbury, Colton, Hao, Claire, Yang, Dongyun, Hui, Susanta, Han, Chunhui, Liu, An, Salhotra, Amandeep, Nakamura, Ryotaro, Rosenthal, Joseph, Stein, Anthony, Wong, Jeffrey, Dandapani, Savita
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9755353/
https://www.ncbi.nlm.nih.gov/pubmed/36531001
http://dx.doi.org/10.3389/fonc.2022.1044539
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author Ladbury, Colton
Hao, Claire
Yang, Dongyun
Hui, Susanta
Han, Chunhui
Liu, An
Salhotra, Amandeep
Nakamura, Ryotaro
Rosenthal, Joseph
Stein, Anthony
Wong, Jeffrey
Dandapani, Savita
author_facet Ladbury, Colton
Hao, Claire
Yang, Dongyun
Hui, Susanta
Han, Chunhui
Liu, An
Salhotra, Amandeep
Nakamura, Ryotaro
Rosenthal, Joseph
Stein, Anthony
Wong, Jeffrey
Dandapani, Savita
author_sort Ladbury, Colton
collection PubMed
description BACKGROUND: With the advent of modern radiation treatment technologies such as intensity modulated radiation therapy (IMRT), there has been increasing interest in its use for total body irradiation (TBI) conditioning regimens for hematopoietic cell transplantation (HCT) to achieve lower doses to critical organs such as the lungs and kidneys. Although this has been reported on in early studies, long-term safety and efficacy data is limited. METHODS: We performed a single institution matched-pair retrospective analysis of patients treated with IMRT TBI and standard TBI between 2010 and 2020 to provide data on long-term outcomes. Patients with hematologic malignancies, who could not tolerate standing for traditional TBI or who received prior radiation received IMRT TBI. Patients were matched based on age, diagnosis, disease status, and year of transplant, and were matched 2:1 to the standard TBI and IMRT TBI cohorts. Patient and treatment characteristics, toxicity, graft-versus-host disease (GVHD), dosimetry, and outcomes were evaluated for each cohort. RESULTS: A total of 13 patients met inclusion criteria for the IMRT cohort, leading to 26 patients in the standard TBI cohort. There was no significant difference in relevant clinical factors between the cohorts. Reasons for using IMRT over conventional TBI included being unable to stand (n=5), prior radiation (n=5), and pediatric patient requiring anesthesia (n=3). Among living patients, median follow-up for all patients was 5.1 years in the IMRT TBI cohort and 5.5 years in the standard TBI cohort. The 5-yr estimate of OS was 68% in the IMRT TBI cohort and 60% in the standard TBI cohort (p=0.706). The 5-yr estimate of RFS was 54% in the IMRT TBI cohort and 60% in the standard TBI cohort (p=0.529). There was no clinically significant pneumonitis, nephritis, hypothyroidism, or cataracts reported in the IMRT TBI cohort. 41.7% of patients in the IMRT TBI cohort and 79.2% of patients in the standard TBI cohort experienced Grade II-IV acute GVHD (p=0.023). CONCLUSIONS: IMRT TBI appears to lead to favorable long-term outcome and dosimetry, and therefore potentially improved long-term toxicity profile compared to conventional TBI. IMRT TBI warrants further investigation as part of larger prospective trials.
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spelling pubmed-97553532022-12-17 Long-term follow up of patients with hematological malignancies treated with total body irradiation using intensity modulated radiation therapy Ladbury, Colton Hao, Claire Yang, Dongyun Hui, Susanta Han, Chunhui Liu, An Salhotra, Amandeep Nakamura, Ryotaro Rosenthal, Joseph Stein, Anthony Wong, Jeffrey Dandapani, Savita Front Oncol Oncology BACKGROUND: With the advent of modern radiation treatment technologies such as intensity modulated radiation therapy (IMRT), there has been increasing interest in its use for total body irradiation (TBI) conditioning regimens for hematopoietic cell transplantation (HCT) to achieve lower doses to critical organs such as the lungs and kidneys. Although this has been reported on in early studies, long-term safety and efficacy data is limited. METHODS: We performed a single institution matched-pair retrospective analysis of patients treated with IMRT TBI and standard TBI between 2010 and 2020 to provide data on long-term outcomes. Patients with hematologic malignancies, who could not tolerate standing for traditional TBI or who received prior radiation received IMRT TBI. Patients were matched based on age, diagnosis, disease status, and year of transplant, and were matched 2:1 to the standard TBI and IMRT TBI cohorts. Patient and treatment characteristics, toxicity, graft-versus-host disease (GVHD), dosimetry, and outcomes were evaluated for each cohort. RESULTS: A total of 13 patients met inclusion criteria for the IMRT cohort, leading to 26 patients in the standard TBI cohort. There was no significant difference in relevant clinical factors between the cohorts. Reasons for using IMRT over conventional TBI included being unable to stand (n=5), prior radiation (n=5), and pediatric patient requiring anesthesia (n=3). Among living patients, median follow-up for all patients was 5.1 years in the IMRT TBI cohort and 5.5 years in the standard TBI cohort. The 5-yr estimate of OS was 68% in the IMRT TBI cohort and 60% in the standard TBI cohort (p=0.706). The 5-yr estimate of RFS was 54% in the IMRT TBI cohort and 60% in the standard TBI cohort (p=0.529). There was no clinically significant pneumonitis, nephritis, hypothyroidism, or cataracts reported in the IMRT TBI cohort. 41.7% of patients in the IMRT TBI cohort and 79.2% of patients in the standard TBI cohort experienced Grade II-IV acute GVHD (p=0.023). CONCLUSIONS: IMRT TBI appears to lead to favorable long-term outcome and dosimetry, and therefore potentially improved long-term toxicity profile compared to conventional TBI. IMRT TBI warrants further investigation as part of larger prospective trials. Frontiers Media S.A. 2022-12-02 /pmc/articles/PMC9755353/ /pubmed/36531001 http://dx.doi.org/10.3389/fonc.2022.1044539 Text en Copyright © 2022 Ladbury, Hao, Yang, Hui, Han, Liu, Salhotra, Nakamura, Rosenthal, Stein, Wong and Dandapani https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Oncology
Ladbury, Colton
Hao, Claire
Yang, Dongyun
Hui, Susanta
Han, Chunhui
Liu, An
Salhotra, Amandeep
Nakamura, Ryotaro
Rosenthal, Joseph
Stein, Anthony
Wong, Jeffrey
Dandapani, Savita
Long-term follow up of patients with hematological malignancies treated with total body irradiation using intensity modulated radiation therapy
title Long-term follow up of patients with hematological malignancies treated with total body irradiation using intensity modulated radiation therapy
title_full Long-term follow up of patients with hematological malignancies treated with total body irradiation using intensity modulated radiation therapy
title_fullStr Long-term follow up of patients with hematological malignancies treated with total body irradiation using intensity modulated radiation therapy
title_full_unstemmed Long-term follow up of patients with hematological malignancies treated with total body irradiation using intensity modulated radiation therapy
title_short Long-term follow up of patients with hematological malignancies treated with total body irradiation using intensity modulated radiation therapy
title_sort long-term follow up of patients with hematological malignancies treated with total body irradiation using intensity modulated radiation therapy
topic Oncology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9755353/
https://www.ncbi.nlm.nih.gov/pubmed/36531001
http://dx.doi.org/10.3389/fonc.2022.1044539
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