ESTRO ACROP and SIOPE recommendations for myeloablative Total Body Irradiation in children

•Toxicity reduction with outcome preservation is a goal of myeloablative TBI in children.•Fractionated TBI of 12–14.4 Gy, in 1.6–2 Gy fractions b.i.d. is advisable for children.•When possible, dose reduction to lungs (<8 Gy), kidneys (≤10 Gy) and lenses (<12 Gy) is appropriate.•Setup considera...

Full description

Saved in:

Bibliographic Details
Published in:	Radiotherapy and Oncology Vol. 173; pp. 119 - 133
Main Authors:	Hoeben, Bianca A.W., Pazos, Montserrat, Seravalli, Enrica, Bosman, Mirjam E., Losert, Christoph, Albert, Michael H., Boterberg, Tom, Ospovat, Inna, Mico Milla, Soraya, Demiroz Abakay, Candan, Engellau, Jacob, Jóhannesson, 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.
Format:	Journal Article
Language:	English
Published:	Ireland Elsevier B.V 01.08.2022 Elsevier BV
Subjects:	Bone Marrow Child Child, Preschool Consensus recommendations Cèl·lules mare hematopoètiques - Trasplantació - Complicacions Hematology Hematology, Oncology, and Palliative Medicine Hematopoietic stem cell transplantation Humans Infants Oncology Other subheadings::Other subheadings::/adverse effects [Other subheadings] Otros calificadores::Otros calificadores::/efectos adversos [Otros calificadores] Pediatric personas::Grupos de Edad::niño::niño preescolar [DENOMINACIONES DE GRUPOS] Persons::Age Groups::Child::Child, Preschool [NAMED GROUPS] Radiology Nuclear Medicine and imaging Radioteràpia Retrospective Studies terapéutica::radioterapia::irradiación corporal total [TÉCNICAS Y EQUIPOS ANALÍTICOS, DIAGNÓSTICOS Y TERAPÉUTICOS] terapéutica::terapia biológica::tratamientos basados en células y tejidos::trasplante de células::trasplante de células madre::trasplante de células madre hematopoyéticas [TÉCNICAS Y EQUIPOS ANALÍTICOS, DIAGNÓSTICOS Y TERAPÉUTICOS] Therapeutics::Biological Therapy::Cell- and Tissue-Based Therapy::Cell Transplantation::Stem Cell Transplantation::Hematopoietic Stem Cell Transplantation [ANALYTICAL, DIAGNOSTIC AND THERAPEUTIC TECHNIQUES, AND EQUIPMENT] Therapeutics::Radiotherapy::Whole-Body Irradiation [ANALYTICAL, DIAGNOSTIC AND THERAPEUTIC TECHNIQUES, AND EQUIPMENT] Total Body Irradiation Transplantation Conditioning Whole-Body Irradiation ALL MOSFET CRT IMRT MLC NRM ALT AYA CNS GVHD TLD TLI TMLI TPS CSI fTBI TBI SIOPE HSCT RT-qPCR Hematopoietic stem cell transplantation AML BED AST CML SSD IP sfTBI AP CVA CVD PA TMI Total Body Irradiation DEXA SOS SAD EQD2 NGS Pediatric MRD Consensus recommendations craniospinal irradiation sinusoidal obstruction syndrome alanine aminotransferase real-time quantitative polymerase chain reaction Non Relapse Mortality hematopoietic stem cell transplantation chronic myeloid leukemia cerebrovascular incident Total Marrow Irradiation interstitial pneumonitis central nervous system source to skin distance source-axis distance dose delivered in 2-Gy fractions that is biologically equivalent to a total dose intensity modulated radiation therapy European Society for Paediatric Oncology metal–oxide–semiconductor field-effect transistor Total Lymphoid Irradiation Dual-energy x-ray absorptiometry multileaf collimator treatment planning system acute myeloid leukemia EQD 2 adolescent and young adults thermoluminescent dosimeter Total Marrow and Lymphoid Irradiation cardiovascular disease next-generation sequencing Anterior-Posterior aspartate aminotransferase cranial radiotherapy single fraction Total Body Irradiation acute lymphoblastic leukemia biologically effective dose minimal residual disease Posterior-Anterior fractionated Total Body Irradiation graft versus host disease
ISSN:	0167-8140, 1879-0887, 1879-0887
Online Access:	Get full text
Tags:	Add Tag No Tags, Be the first to tag this record!

Description
Summary:	•Toxicity reduction with outcome preservation is a goal of myeloablative TBI in children.•Fractionated TBI of 12–14.4 Gy, in 1.6–2 Gy fractions b.i.d. is advisable for children.•When possible, dose reduction to lungs (<8 Gy), kidneys (≤10 Gy) and lenses (<12 Gy) is appropriate.•Setup considerations for conventional and highly conformal TBI techniques in children.•Cooperation can support new insights, research and implementation of new techniques. 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 practices and improve the outcome versus toxicity ratio for children. 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. 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. 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.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	0167-8140 1879-0887 1879-0887
DOI:	10.1016/j.radonc.2022.05.027