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Total marrow and lymphoid irradiation with helical tomotherapy: a practical implementation report

Radiation Oncology Journal 2020년 38권 3호 p.207 ~ 216
Chilukuri Srinivas, Sundar Sham, Thiyagarajan Rajesh, Easow Jose, Sawant Mayur, Krishanan Ganapathy, Panda Pankaj Kumar, Sharma Dayananda, Jalali Rakesh,
소속 상세정보
 ( Chilukuri Srinivas ) - Apollo Proton Cancer Centre Department of Radiation Oncology
 ( Sundar Sham ) - Apollo Proton Cancer Centre Department of Radiation Oncology
 ( Thiyagarajan Rajesh ) - Apollo Proton Cancer Centre Department of Medical Physics
 ( Easow Jose ) - Apollo Specialty Hospital Department of Haematology, Blood and Marrow Transplantation
 ( Sawant Mayur ) - Apollo Proton Cancer Centre Department of Medical Physics
 ( Krishanan Ganapathy ) - Apollo Proton Cancer Centre Department of Medical Physics
 ( Panda Pankaj Kumar ) - Apollo Proton Cancer Centre Department of Clinical Research
 ( Sharma Dayananda ) - Apollo Proton Cancer Centre Department of Medical Physics
 ( Jalali Rakesh ) - Apollo Proton Cancer Centre Department of Radiation Oncology

Abstract


Purpose: To standardize the technique; evaluate resources requirements and analyze our early experience of total marrow and lymphoid irradiation (TMLI) as part of the conditioning regimen before allogenic bone marrow transplantation using helical tomotherapy.

Materials and Methods: Computed tomography (CT) scanning and treatment were performed in head first supine (HFS) and feet first supine (FFS) orientations with an overlap at mid-thigh. Patients along with the immobilization device were manually rotated by 180° to change the orientation after the delivery of HFS plan. The dose at the junction was contributed by a complementary dose gradient from each of the plans. Plan was to deliver 95% of 12 Gy to 98% of clinical target volume with dose heterogeneity <10% and pre-specified organs-at-risk dose constraints. Megavoltage-CT was used for position verification before each fraction. Patient specific quality assurance and in vivo film dosimetry to verify junction dose were performed in all patients.

Results: Treatment was delivered in two daily fractions of 2 Gy each for 3 days with at least 8-hour gap between each fraction. The target coverage goals were met in all the patients. The average person-hours per patient were 16.5, 21.5, and 25.75 for radiation oncologist, radiation therapist, and medical physicist, respectively. Average in-room time per patient was 9.25 hours with an average beam-on time of 3.32 hours for all the 6 fractions.

Conclusion: This report comprehensively describes technique and resource requirements for TMLI and would serve as a practical guide for departments keen to start this service. Despite being time and labor intensive, it can be implemented safely and robustly.

키워드

Total body irradiation; Lymphoid irradiation; Stem cell transplantation; Hematopoietic; Helical tomotherapy; Resource allocations

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