Safety of total body irradiation using intensity-modulated radiation therapy by helical tomotherapy in allogeneic hematopoietic stem cell transplantation: a prospective pilot study

医学 全身照射 断层治疗 粘膜炎 造血干细胞移植 内科学 临床终点 胃肠病学 不利影响 移植 养生 外科 入射(几何) 放射治疗 单中心 化疗 临床试验 环磷酰胺 物理 光学
作者
Tatsuya Konishi,Hiroaki Ogawa,Yuho Najima,Shinpei Hashimoto,Atsushi Wada,Hiroto Adachi,Ryosuke Konuma,Yuya Kishida,Akihito Nagata,Yuta Yamada,Satoshi Kaito,Junichi Mukae,Atsushi Marumo,Yuma Noguchi,Takashi Toya,Aiko Igarashi,Takeshi Kobayashi,Kazuteru Ohashi,Noriko Doki,Katsuyuki Karasawa
出处
期刊:Journal of Radiation Research [Oxford University Press]
卷期号:61 (6): 969-976 被引量:15
标识
DOI:10.1093/jrr/rraa078
摘要

Abstract Total body irradiation using intensity-modulated radiation therapy total body irradiation (IMRT-TBI) by helical tomotherapy in allogeneic hematopoietic stem cell transplantation (allo-HSCT) allows for precise evaluation and adjustment of radiation dosage. We conducted a single-center pilot study to evaluate the safety of IMRT-TBI for allo-HSCT recipients. Patients with hematological malignancies in remission who were scheduled for allo-HSCT with TBI-based myeloablative conditioning were eligible. The primary endpoint was the incidence of adverse events (AEs). Secondary endpoints were engraftment rate, overall survival, relapse rate, non-relapse mortality, and the incidence of acute and chronic graft-versus-host disease (aGVHD and cGVHD, respectively). Between July 2018 and November 2018, ten patients were recruited with a median observation duration of 571 days after allo-HSCT (range, 496–614). D80% for planning target volume (PTV) in all patients was 12.01 Gy. Average D80% values for lungs, kidneys and lenses (right/left) were 7.50, 9.03 and 4.41/4.03 Gy, respectively. Any early AEs (within 100 days of allo-HSCT) were reported in all patients. Eight patients experienced oral mucositis and gastrointestinal symptoms. One patient experienced Bearman criteria grade 3 regimen-related toxicity (kidney and liver). All cases achieved neutrophil engraftment. There was no grade III–IV aGVHD or late AE. One patient died of sinusoidal obstruction syndrome 67 days after allo-HSCT. The remaining nine patients were alive and disease-free at final follow-up. Thus, IMRT-TBI was well tolerated in terms of early AEs in adult patients who underwent allo-HSCT; this warrants further study with longer observation times to monitor late AEs and efficacy.
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