Modern Radiation for Hematologic Stem Cell Transplantation: Total Marrow and Lymphoid Irradiation or Intensity-Modulated Radiation Therapy Total Body Irradiation

Claire Hao; Colton Ladbury; Jeffrey Wong; Savita Dandapani

doi:10.1016/j.soc.2023.03.001

Modern Radiation for Hematologic Stem Cell Transplantation: Total Marrow and Lymphoid Irradiation or Intensity-Modulated Radiation Therapy Total Body Irradiation

Surg Oncol Clin N Am. 2023 Jul;32(3):475-495. doi: 10.1016/j.soc.2023.03.001. Epub 2023 Apr 8.

Authors

Claire Hao¹, Colton Ladbury¹, Jeffrey Wong¹, Savita Dandapani²

Affiliations

¹ Department of Radiation Oncology, City of Hope, 1500 East Duarte Road, Duarte, CA 91010, USA.
² Department of Radiation Oncology, City of Hope, 1500 East Duarte Road, Duarte, CA 91010, USA. Electronic address: sdandapani@coh.org.

PMID: 37182988
DOI: 10.1016/j.soc.2023.03.001

Abstract

The development of large-field intensity-modulated radiation therapy (IMRT) has enabled the implementation of total marrow irradiation (TMI), total marrow and lymphoid irradiation (TMLI), and IMRT total body irradiation (TBI). IMRT TBI limits doses to organs at risk, primarily the lungs and in some cases the kidneys and lenses, which may mitigate complications. TMI/TMLI allows for dose escalation above TBI radiation therapy doses to malignant sites while still sparing organs at risk. Although still sparingly used, these techniques have established feasibility and demonstrated promise in reducing the adverse effects of TBI while maintaining and potentially improving survival outcomes.

Keywords: Acute leukemia; Boost; Helical TomoTherapy; IMRT TBI; SIB; TMI; TMLI; VMAT.

Publication types

Review
Research Support, Non-U.S. Gov't

MeSH terms

Bone Marrow* / radiation effects
Humans
Lymphatic Irradiation / methods
Radiotherapy Dosage
Radiotherapy, Intensity-Modulated* / adverse effects
Stem Cell Transplantation
Whole-Body Irradiation / adverse effects
Whole-Body Irradiation / methods