Helical Versus Static Approaches to Delivering Tomotherapy to the Junctional Target for Patients Taller Than 135 cm Undergoing Total Body Irradiation

Overview

Journal Eur J Med Res

Publisher Biomed Central

Specialty General Medicine

Date 2022 Nov 26

PMID 36434707

Authors

Mumtaz Koksal

Jonathan Baumert

Felix Schoroth

Thomas Mudder

Davide Scafa

David Koch

Christina Leitzen

Gustavo R Sarria

Leonard C Schmeel

Frank A Giordano

Affiliations

Soon will be listed here.

Abstract

Background: Helical TomoTherapy is widely used for total body irradiation as a component of conditioning regimens before allogeneic bone-marrow transplantation. However, this technique limits the maximum length of a planning target volume to 135 cm. Therefore, patients taller than 135 cm require two planning computed tomography scans and treatment plans. The junctional target between these two treatment plans is thus a critical region for treatment planning and delivery. Here, we compare radiation coverage of the junctional target between helical and static approaches to treatment planning and delivery to determine which approach allows high quality irradiation planning and provides more robustness against patient movement.

Methods: We retrospectively analyzed 10 patients who underwent total body irradiation using a static four-field box planning approach and nine patients who underwent total body irradiation using a helical planning approach. All patients were taller than 135 cm. The junctional target volume was divided into 10 slices of 1 cm thickness (JT-JT) for analysis. Dosimetric parameters and dose-volume histograms were compared to assess the quality of coverage of the junctional target between the helical and static planning approaches.

Results: The D for the total junctional target was slightly higher than the prescribed dose for both helical and static approaches, with a mean of 108.12% for the helical group and 107.81% for the static group. The mean D was 98.44% ± 4.19% for the helical group and 96.20% ± 4.59% for the static group. The mean homogeneity index covering the entire junctional target volume was 1.20 ± 0.04 for the helical group and 1.21 ± 0.05 for the static group. The mean homogeneity index ranged from 1.08 ± 0.01 in JT to 1.22 ± 0.06 in JT for the helical group and from 1.06 ± 0.02 in JT to 1.19 ± 0.05 in JT for the static group. There were no significant differences in parameters between helical and static groups. However, the static approach provided robustness against up to 30 mm of lateral movement of the patient.

Conclusions: As long as TBI using helical TomoTherapy is limited to a maximum length of 135 cm, the junctional target must be addressed during treatment planning. Our analysis shows that the static four-field box approach is viable and offers higher robustness against lateral movement of the patient than the helical approach.

Citing Articles

A multi-institutional survey on technical variations in total body irradiation in Japan.

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References

Wong J, Filippi A, Shbib Dabaja B, Yahalom J, Specht L . Total Body Irradiation: Guidelines from the International Lymphoma Radiation Oncology Group (ILROG). Int J Radiat Oncol Biol Phys. 2018; 101(3):521-529. DOI: 10.1016/j.ijrobp.2018.04.071. View

Penagaricano J, Chao M, van Rhee F, Moros E, Corry P, Ratanatharathorn V . Clinical feasibility of TBI with helical tomotherapy. Bone Marrow Transplant. 2010; 46(7):929-35. DOI: 10.1038/bmt.2010.237. View

Haraldsson A, Engellau J, Lenhoff S, Engelholm S, Back S, Engstrom P . Implementing safe and robust Total Marrow Irradiation using Helical Tomotherapy - A practical guide. Phys Med. 2019; 60:162-167. DOI: 10.1016/j.ejmp.2019.03.032. View

Kataria T, Sharma K, Subramani V, Karrthick K, Bisht S . Homogeneity Index: An objective tool for assessment of conformal radiation treatments. J Med Phys. 2013; 37(4):207-13. PMC: 3532749. DOI: 10.4103/0971-6203.103606. View

Moliner G, Izar F, Ferrand R, Bardies M, Ken S, Simon L . Virtual bolus for total body irradiation treated with helical tomotherapy. J Appl Clin Med Phys. 2015; 16(6):164–176. PMC: 5691005. DOI: 10.1120/jacmp.v16i6.5580. View

Shueng P, Lin S, Chong N, Lee H, Tien H, Wu L . Total marrow irradiation with helical tomotherapy for bone marrow transplantation of multiple myeloma: first experience in Asia. Technol Cancer Res Treat. 2009; 8(1):29-38. DOI: 10.1177/153303460900800105. View

De Felice F, Grapulin L, Musio D, Pomponi J, Di Felice C, Iori A . Treatment Complications and Long-term Outcomes of Total Body Irradiation in Patients with Acute Lymphoblastic Leukemia: A Single Institute Experience. Anticancer Res. 2016; 36(9):4859-64. DOI: 10.21873/anticanres.11049. View

Wang H, Liu J, Pi Y, Liu Q, Mi Y, Yang X . Technical note: factors affecting dose distribution in the overlap region of two-segment total body irradiation by helical tomotherapy. Radiat Oncol. 2020; 15(1):257. PMC: 7648982. DOI: 10.1186/s13014-020-01698-x. View

Feuvret L, Noel G, Mazeron J, Bey P . Conformity index: a review. Int J Radiat Oncol Biol Phys. 2006; 64(2):333-42. DOI: 10.1016/j.ijrobp.2005.09.028. View

10.

Marks L, Yorke E, Jackson A, Ten Haken R, Constine L, Eisbruch A . Use of normal tissue complication probability models in the clinic. Int J Radiat Oncol Biol Phys. 2010; 76(3 Suppl):S10-9. PMC: 4041542. DOI: 10.1016/j.ijrobp.2009.07.1754. View

11.

Stein A, Forman S . Allogeneic transplantation for ALL in adults. Bone Marrow Transplant. 2008; 41(5):439-46. DOI: 10.1038/bmt.2008.1. View

12.

Zeverino M, Agostinelli S, Taccini G, Cavagnetto F, Garelli S, Gusinu M . Advances in the implementation of helical tomotherapy-based total marrow irradiation with a novel field junction technique. Med Dosim. 2012; 37(3):314-20. DOI: 10.1016/j.meddos.2011.12.001. View

13.

Hui S, Kapatoes J, Fowler J, Henderson D, Olivera G, Manon R . Feasibility study of helical tomotherapy for total body or total marrow irradiation. Med Phys. 2005; 32(10):3214-24. DOI: 10.1118/1.2044428. View

14.

Schultheiss T, Wong J, Liu A, Olivera G, Somlo G . Image-guided total marrow and total lymphatic irradiation using helical tomotherapy. Int J Radiat Oncol Biol Phys. 2007; 67(4):1259-67. DOI: 10.1016/j.ijrobp.2006.10.047. View

15.

Takenaka R, Haga A, Nawa K, Hideomi Y, Nakagawa K . Improvement of the robustness to set up error by a virtual bolus in total scalp irradiation with Helical TomoTherapy. Radiol Phys Technol. 2019; 12(4):433-437. DOI: 10.1007/s12194-019-00539-1. View

16.

Cahu X, Labopin M, Giebel S, Aljurf M, Kyrcz-Krzemien S, Socie G . Impact of conditioning with TBI in adult patients with T-cell ALL who receive a myeloablative allogeneic stem cell transplantation: a report from the acute leukemia working party of EBMT. Bone Marrow Transplant. 2015; 51(3):351-7. DOI: 10.1038/bmt.2015.278. View

17.

Ringden O, Labopin M, Ehninger G, Niederwieser D, Olsson R, Basara N . Reduced intensity conditioning compared with myeloablative conditioning using unrelated donor transplants in patients with acute myeloid leukemia. J Clin Oncol. 2009; 27(27):4570-7. DOI: 10.1200/JCO.2008.20.9692. View

18.

Wilhelm-Buchstab T, Leitzen C, Schmeel L, Simon B, Koch D, Schmeel F . Total body irradiation: Significant dose sparing of lung tissue achievable by helical tomotherapy. Z Med Phys. 2019; 30(1):17-23. DOI: 10.1016/j.zemedi.2019.05.002. View

19.

Quast U . Whole body radiotherapy: A TBI-guideline. J Med Phys. 2011; 31(1):5-12. PMC: 3003894. DOI: 10.4103/0971-6203.25664. View

20.

Wong J, Rosenthal J, Liu A, Schultheiss T, Forman S, Somlo G . Image-guided total-marrow irradiation using helical tomotherapy in patients with multiple myeloma and acute leukemia undergoing hematopoietic cell transplantation. Int J Radiat Oncol Biol Phys. 2008; 73(1):273-9. PMC: 3896447. DOI: 10.1016/j.ijrobp.2008.04.071. View