CONCLUSION
VMAT-TBI is a modern alternative to conventional 2D-TBI treatment, offering superior lung sparing with superior target coverage and similar global Dmax. In addition, VMAT-TBI plans using auto-planning scripts provided significant dose reductions in gonads, kidneys, brain, thyroid and lenses.
1. Hartman, A. R., Williams, S. F., & Dillion, J. J. (1998). Survival, disease-free survival and adverse effects of conditioning for allogeneic bone marrow transplantation with busulfan/ cyclophosphamide vs total body irradiation: a meta-analysis. 439-443.
2. Kelsey, C. R., Horwitz, M. E., Chino, J., Craciunescu, O., Steffey, B., Folz, R. J., . . . Marks, L. B. (2011). Severe Pulmonary Toxicity After Myeloablative Conditioning Using Total Body Irradition: An Assessment of Risk Factor. International Journal of Radiation Oncology Biology Physics , Clinical Investigation, Vol. 81, issue 3, 812-818.
3. Wong JYC, Filippi AR, Dabaja BS, Yahalom J, Specht L. (2018). Total Body Irradiation: Guidelines from the International Lymphoma Radiation Oncology Group (ILROG). Int J Radiat Oncol Biol Phys. Jul 1;101(3):521-529.
4. Mark C. Benyunes, Keith M. Sullivan, H. Joachim Deeg, Motomi Mori, Wally Meyer, Lyly Fisher, Richard Benisnger, Marious K. Jack, John Hicks, Robert Witherspoon, C. Dean Buckner, John A. Hansen, Frederick R. Appelbaum, Rainer Storb. (1995). Cataracts after bone marrow transplantation: Long-term follow-up of adults treated with fractionated total body irradiation. International Journal of Radiation Oncology Biology Physics , Vol. 32, Issue 3: 661-670.
5. Tauchmanova L., Selleri C., De Rosa G. et al. High prevalence of endocrine dysfunction in long‐term survivors after allogeneic bone marrow transplantation for hematologic diseases. American Cancer Society Journals . 2002; Vol. 95, Issue 5: 1076-1084
6. Gerstein J., Meyer A., Sykora K.W., et al. Long-Term Renal Toxicity in Children Following Fractionated Total-Body Irradiation (TBI) Before Allogeneic Stem Cell Transplantation (SCT). Strahlenther Onkol.2009; vol. 185: 751-755
7. Abboud I., Porcher R., Robin M., et al. Chronic Kidney Dysfunction in Patients Alive without Relapse 2 Years after Allogeneic Hematopoietic Stem Cell Transplantation. Biol Blood Marrow Transplant. 2009; vol. 15, issue 10: 1251-1257
8. Benmiloud S., Steffens M., Beauloye V., et al. Long-Term Effects on Bone Mineral Density of Different Therapeutic Schemes for Acute Lymphoblastic Leukemia or Non-Hodgkin Lymphoma during Childhood.Horm Res Paediatr. 2010; vol .74: 241-250
9. P. Rassiah, N. Esiashvili, A.J. Olch, D.S. Followill, T.J. FitzGerald, J.A. Kalapurakal etc. (2020). Practice Patterns of Pediatric Total Body Irradiation (TBI) Techniques: A Children’s Oncology Group Survey. International Journal of Radiation Oncology Biology Physics vol. 108 , issue 3; SUPPLEMENT , E234-E235
10. Esiashvili, N., Lu, X., Ulin, K., Laurie, F., Kessel, S., Kalapurakal, J., . . . Pulsipher, M. A. (2019). Higher reported lung dose received during total bodyirradiation for allogeneiv hematopoietic stem cell transplantation in children with acutelymphoblastic leukemia is associated wtih inferior survival: A report from the Children’sOncology Group. International Journal of Radiation Oncology Biology Physics , vol. 104, issue 3; 513-521.
11. Penagaricano, J., Chao, M., Van Rhee, F., Moros, E., Corry, P., & Ratanatharathorn, V. (2011). Clinical Feasibility of TBI with Helical Tomotherapy. Macmillan Publishers Limited , 929-935.
12. Tas, B., Durmus, I. F., Okumus, A., Omer, E. U., Gokce, M., Goksoy, H. S., & Ozsahin, E. M. (2018). Total-Body Irradiation using linac-based volumetric modulated arc therapy: Its clinical accuracy, feasibility, and reliability. The Green Journal Radiation and Oncology , vol. 129, issue 3; 527-533.
13. Blomain, E. S., Kovalchuk, N., Neilsen, B. K., Skinner, L., Hoppe, R. T., & Hiniker, S. M. (2020). A Preliminary Report of Gonadal-Sparing TBI using a VMAT Technique. Practical Radiation Oncology , e1-e5.
14. Ouyang, L., Folkerts, M., Zhang, Y., Hrycishko, B., Lamphier, R., Lee, P., . . . Gu, X. (2017). Volumetric Modulated Arc Therapy based total body irradiation: Workflow and clinical experience with an indexed rotational immobilization system. Elsevier Irelenad , vol. 4; 22-25.
15. Chakraborty, S., Cheruliyil, S., Bharthan, R. K., & Geetha, M. (2015). Total Body Irradiation usingVMAT (RapidArc): A Planning Study of a novel treatment delivery method. International Journal of Cancer Therapy and Oncology , 1-7.
16. Simiele E, Skinner L, Yang Y, Blomain ES, Hoppe RT, Hiniker SM, Kovalchuk N. A Step Toward Making VMAT TBI More Prevalent: Automating the Treatment Planning Process. Pract Radiat Oncol. 2021 Mar 10:S1879-8500(21)00061-8.
17. Kovalchuk, N., Simiele, E., Skinner, L., Yang, Y., Howell, N., Lewis, J., Hui, C., Blomain, E., Hoppe, R.T. and Hiniker, S.M., 2022. The Stanford Volumetric Modulated Arc Therapy Total Body Irradiation Technique. Practical Radiation Oncology12 (3), pp.245-258.
18. Marquez, Cesar, Caressa Hui, Eric Simiele, Erik Blomain, Justin Oh, Alice Bertaina, Orly Klein et al. ”Volumetric modulated arc therapy total body irradiation in pediatric and adolescent/young adult patients undergoing stem cell transplantation: Early outcomes and toxicities.Pediatric Blood & Cancer 69, no. 6 (2022): e29689.
Figure 1: Dose distribution on the coronal view for patient 4 with gonadal sparing for the 2D plan (left) and VMAT (right).
Figure 2: DVH comparison for the VMAT and 2D TBI treatment techniques for patient 3.