The participation of the following European Group for Blood and Marrow Transplantation (EBMT) centers is kindly acknowledged: CIC 160, Necker Hospital, Paris, France; CIC 726, University of Liege, Liege, Belgium; CIC 810, University of Freiburg, Freiburg, Germany; CIC 183, National Center of Bone Marrow Transplant, Tunis, Tunisia; CIC 202, University Hospital, Basel, Switzerland; CIC 751, St. Savas Oncology Hospital, Athens, Greece; CIC 428, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch, Gliwice, Poland; CIC 859, National Hospital of Hematological Diseases, Sofia, Bulgaria; CIC 323, University Hospital Virgen de la Arrixaca, Murcia, Spain; CIC 544, San Gerardo Hospital, Monza, Italy; CIC 208, University Hospital, Zurich, Switzerland; CIC 206, Rigshospitalet, Copenhagen, Denmark; CIC 682, University of Pecs, Pecs, Hungary; CIC 727, Lnico Hospital, Salamanca, Spain; CIC 259, University Hospital, Essen, Germany; CIC 728, Puerta de Hierro University Hospital, Madrid, Spain; CIC 240, Bologna University, Bologna, Italy; CIC 926, CHU Lapeyronie, Montpellier, France; CIC 283, University Hospital, Lund, Sweden; CIC 576, Carlos Haya Hospital, Malaga, Spain; CIC 546, University Medical Center Groningen, Groningen, the Netherlands; CIC 755, Schneider Children's Medical Center of Israel, Petach-Tikva, Israel; CIC 237, Radboud University-Nijmegen Medical Centre, Nijmegen, the Netherlands; CIC 749, Oldenburg Clinic, Oldenburg, Germany; CIC 661, Rennes University Medical Center, Rennes, France; CIC 640, University Medical Center, Ljubljana, Slovenia; CIC 996, Antwerp University Hospital, Antwerp, Belgium; CIC 244, West of Scotland Cancer Centre, Glasgow, Scotland, United Kingdom; CIC 625, Nurnberg Clinic, Nurnberg, Germany; CIC 295, Hannover Medical School, Hannover, Germany; CIC 710, RP Group, Royal Perth Hospital, Perth, Western Australia, Australia; CIC 754, Chaim Sheba Medical Center, Tel-Hashomer, Israel; CIC 266, University Hospital, Uppsala, Sweden; CIC 672, Hautepierre Hospital, Strasbourg, France; Paul Strauss Center, Strasbourg, France; CIC 241, Leon Berard Center, Lyon, France; CIC 169, Gazi Universitesi Tip Fakültesi Hastanesi, Ankara, Turkey; CIC 152, Augsburg Clinic, Augsburg, Germany; CIC 613, Germans Trias i Pujol University Hospital, Barcelona, Spain; CIC 659, CHU Morvan, Brest, France; CIC 246, Erasmus Medical Center-Daniel den Hoed Cancer Centre, Rotterdam, the Netherlands; CIC 257, St James Hospital, Trinity College, Dublin, Ireland; CIC 242, Marques de Valdecilla University Hospital, Santander, Spain; CIC 265, Maggiore di Milano Hospital, Milan, Italy; CIC 813, San Raffaele Scientific Institute, Milan, Italy; CIC 432, Henri-Mondor Hospital, Creteil, France; CIC 397, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia; CIC 232, La Sapienza University, Rome, Italy; CIC 227, Wien Medical University, Vienna, Austria; CIC 260, Santa Creu i Sant Pau Hospital, Barcelona, Spain; CIC 658, Riuniti di Bergamo Hospital, Bergamo, Italy; CIC 646, Heilig Hartziekenhuis, Roeselare, Belgium; CIC 217, San Martino Hospital, Genoa, Italy; CIC 261, University Hospital of Geneva, Geneva, Switzerland; CIC 409, Beilinson Hospital, Petach-Tikva, Israel; CIC 302, University Hospital Center Rebro, Zagreb, Croatia; CIC 800, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland; CIC 505, Pediatric Clinic/Outpatient Department, Department of Radiotherapy-Radiooncology, Munster, Germany.
Extreme heterogeneity of myeloablative total body irradiation techniques in clinical practice: A survey of the Acute Leukemia Working Party of the European Group for Blood and Marrow Transplantation
Article first published online: 7 MAY 2014
© 2014 American Cancer Society
Volume 120, Issue 17, pages 2760–2765, September 1, 2014
How to Cite
Giebel, S., Miszczyk, L., Slosarek, K., Moukhtari, L., Ciceri, F., Esteve, J., Gorin, N.-C., Labopin, M., Nagler, A., Schmid, C. and Mohty, M. (2014), Extreme heterogeneity of myeloablative total body irradiation techniques in clinical practice: A survey of the Acute Leukemia Working Party of the European Group for Blood and Marrow Transplantation. Cancer, 120: 2760–2765. doi: 10.1002/cncr.28768
- Issue published online: 20 AUG 2014
- Article first published online: 7 MAY 2014
- Manuscript Accepted: 27 FEB 2014
- Manuscript Revised: 24 FEB 2014
- Manuscript Received: 2 JAN 2014
- total body irradiation;
- hematopoietic stem cell transplantation;
- radiotherapy dose;
- radiotherapy fractionation;
- radiation dosimetry
Total body irradiation (TBI) is widely used for conditioning before hematopoietic cell transplantation. Its efficacy and toxicity may depend on many methodological aspects. The goal of the current study was to explore current clinical practice in this field.
A questionnaire was sent to all centers collaborating in the European Group for Blood and Marrow Transplantation and included 19 questions regarding various aspects of TBI. A total of 56 centers from 23 countries responded.
All centers differed with regard to at least 1 answer. The total maximum dose of TBI used for myeloablative transplantation ranged from 8 grays (Gy) to 14.4 Gy, whereas the dose per fraction was 1.65 Gy to 8 Gy. A total of 16 dose/fractionation modalities were identified. The dose rate ranged from 2.25 centigrays to 37.5 centigrays per minute. The treatment unit was linear accelerator (LINAC) (91%) or cobalt unit (9%). Beams (photons) used for LINAC were reported to range from 6 to 25 megavolts. The most frequent technique used for irradiation was “patient in 1 field,” in which 2 fields and 2 patient positions per fraction are used (64%). In 41% of centers, patients were immobilized during TBI. Approximately 93% of centers used in vivo dosimetry with accepted discrepancies between the planned and measured doses of 1.5% to 10%. In 84% of centers, the lungs were shielded during irradiation. The maximum accepted dose for the lungs was 6 Gy to 14.4 Gy.
TBI is an extremely heterogeneous treatment modality. The findings of the current study should warrant caution in the interpretation of clinical studies involving TBI. Further investigation is needed to evaluate how methodological differences influence outcome. Efforts to standardize the method should be considered. Cancer 2014;120:2760–2765. © 2014 American Cancer Society.