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Implementing safe and robust Total Marrow Irradiation using Helical Tomotherapy – A practical guide

Haraldsson, André LU ; Engellau, Jacob LU ; Lenhoff, Stig LU ; Engelholm, Silke ; Bäck, Sven LU and Engström, Per E. LU (2019) In Physica Medica 60. p.162-167
Abstract

Total Marrow Irradiation (TMI) with Helical Tomotherapy is a radiotherapy treatment technique that targets bone marrow and sanctuary sites prior to stem cell or bone marrow transplantation (SCT/BMT). TMI is a complex procedure that involves several critical steps that all need to be carefully addressed for a successful implementation, such as dose homogeneity in field junctions, choice of target margins, integrity of treatment and back-up planning. In this work we present our solution for a robust and reproducible workflow throughout the treatment chain and data for twenty-three patients treated to date. Material & Methods: Patients were immobilized in a whole body vacuum cushion and thermoplastic mask. CT-scanning and treatment... (More)

Total Marrow Irradiation (TMI) with Helical Tomotherapy is a radiotherapy treatment technique that targets bone marrow and sanctuary sites prior to stem cell or bone marrow transplantation (SCT/BMT). TMI is a complex procedure that involves several critical steps that all need to be carefully addressed for a successful implementation, such as dose homogeneity in field junctions, choice of target margins, integrity of treatment and back-up planning. In this work we present our solution for a robust and reproducible workflow throughout the treatment chain and data for twenty-three patients treated to date. Material & Methods: Patients were immobilized in a whole body vacuum cushion and thermoplastic mask. CT-scanning and treatment were performed in two parts with field matching at the upper thigh. Target consisted of marrow containing bone and sanctuary sites. Lungs, kidneys, bowel, heart and liver were defined as organs at risk (OAR). A fast surface scanning system was used to position parts of the body not covered by the imaging system (MVCT) as well as to reduce treatment time. Results: All patients completed their treatment and could proceed with SCT/BMT. Doses to OARs were significantly reduced and target dose homogeneity was improved compared to TBI. Robustness tests performed on field matching and patient positioning support that the field junction technique is adequate. Replacing MVCT with optical surface scanning reduced the treatment time by 25 min per fraction. Conclusion: The methodology presented here has shown to provide a safe, robust and reproducible treatment for Total Marrow Irradiation using Tomotherapy.

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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Helical, Irradiation, Marrow, Radiotherapy, TMI, Tomotherapy, Total
in
Physica Medica
volume
60
pages
6 pages
publisher
ISTITUTI EDITORIALI E POLGRAFICI INTERNAZIONALI
external identifiers
  • scopus:85063767934
ISSN
1120-1797
DOI
10.1016/j.ejmp.2019.03.032
language
English
LU publication?
yes
id
22a22343-a39c-4f1d-845d-bc13e9ed85ae
date added to LUP
2019-04-23 12:38:34
date last changed
2019-11-25 09:29:09
@article{22a22343-a39c-4f1d-845d-bc13e9ed85ae,
  abstract     = {<p>Total Marrow Irradiation (TMI) with Helical Tomotherapy is a radiotherapy treatment technique that targets bone marrow and sanctuary sites prior to stem cell or bone marrow transplantation (SCT/BMT). TMI is a complex procedure that involves several critical steps that all need to be carefully addressed for a successful implementation, such as dose homogeneity in field junctions, choice of target margins, integrity of treatment and back-up planning. In this work we present our solution for a robust and reproducible workflow throughout the treatment chain and data for twenty-three patients treated to date. Material &amp; Methods: Patients were immobilized in a whole body vacuum cushion and thermoplastic mask. CT-scanning and treatment were performed in two parts with field matching at the upper thigh. Target consisted of marrow containing bone and sanctuary sites. Lungs, kidneys, bowel, heart and liver were defined as organs at risk (OAR). A fast surface scanning system was used to position parts of the body not covered by the imaging system (MVCT) as well as to reduce treatment time. Results: All patients completed their treatment and could proceed with SCT/BMT. Doses to OARs were significantly reduced and target dose homogeneity was improved compared to TBI. Robustness tests performed on field matching and patient positioning support that the field junction technique is adequate. Replacing MVCT with optical surface scanning reduced the treatment time by 25 min per fraction. Conclusion: The methodology presented here has shown to provide a safe, robust and reproducible treatment for Total Marrow Irradiation using Tomotherapy.</p>},
  author       = {Haraldsson, André and Engellau, Jacob and Lenhoff, Stig and Engelholm, Silke and Bäck, Sven and Engström, Per E.},
  issn         = {1120-1797},
  language     = {eng},
  pages        = {162--167},
  publisher    = {ISTITUTI EDITORIALI E POLGRAFICI INTERNAZIONALI},
  series       = {Physica Medica},
  title        = {Implementing safe and robust Total Marrow Irradiation using Helical Tomotherapy – A practical guide},
  url          = {http://dx.doi.org/10.1016/j.ejmp.2019.03.032},
  doi          = {10.1016/j.ejmp.2019.03.032},
  volume       = {60},
  year         = {2019},
}