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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 and Demiroz Abakay, Candan , et al. (2022) In Radiotherapy and Oncology 173. p.119-133
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 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... (More)

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 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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publishing date
type
Contribution to journal
publication status
published
keywords
Bone Marrow, Child, Child, Preschool, Hematopoietic Stem Cell Transplantation/adverse effects, Humans, Retrospective Studies, Transplantation Conditioning/methods, Whole-Body Irradiation/adverse effects
in
Radiotherapy and Oncology
volume
173
pages
119 - 133
publisher
Elsevier
external identifiers
  • pmid:35661674
  • scopus:85132748580
ISSN
1879-0887
DOI
10.1016/j.radonc.2022.05.027
language
English
LU publication?
no
additional info
Copyright © 2022 The Author(s). Published by Elsevier B.V. All rights reserved.
id
d4b2f96c-a005-49a6-b129-0f99152eb704
date added to LUP
2022-11-26 16:55:51
date last changed
2024-06-14 23:31:06
@article{d4b2f96c-a005-49a6-b129-0f99152eb704,
  abstract     = {{<p>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 practices and improve the outcome versus toxicity ratio for children.</p><p>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.</p><p>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 &lt;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 &lt;8 Gy, for the kidneys to ≤10 Gy, and for the lenses to &lt;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.</p><p>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.</p>}},
  author       = {{Hoeben, Bianca A W and Pazos, Montserrat and Seravalli, Enrica and Bosman, Mirjam E and Losert, Christoph and Albert, Michael H and Boterberg, Tom and Ospovat, Inna and Mico Milla, Soraya and Demiroz Abakay, Candan and Engellau, Jacob and Jóhannesson, Vilberg and Kos, Gregor and Supiot, Stéphane and Llagostera, Camille and Bierings, Marc and Scarzello, Giovanni and Seiersen, Klaus and Smith, Ed and Ocanto, Abrahams and Ferrer, Carlos and Bentzen, Søren M and Kobyzeva, Daria A and Loginova, Anna A and Janssens, Geert O}},
  issn         = {{1879-0887}},
  keywords     = {{Bone Marrow; Child; Child, Preschool; Hematopoietic Stem Cell Transplantation/adverse effects; Humans; Retrospective Studies; Transplantation Conditioning/methods; Whole-Body Irradiation/adverse effects}},
  language     = {{eng}},
  pages        = {{119--133}},
  publisher    = {{Elsevier}},
  series       = {{Radiotherapy and Oncology}},
  title        = {{ESTRO ACROP and SIOPE recommendations for myeloablative Total Body Irradiation in children}},
  url          = {{http://dx.doi.org/10.1016/j.radonc.2022.05.027}},
  doi          = {{10.1016/j.radonc.2022.05.027}},
  volume       = {{173}},
  year         = {{2022}},
}