Sistema de Salut de Catalunya
Institut Català de la Salut
[Hoeben BAW] Dept. of Radiation Oncology, University Medical Center Utrecht, The Netherlands. Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands. [Pazos M, Losert C] Dept. of Radiation Oncology, University Hospital, LMU Munich, Germany. [Seravalli E, Bosman ME] Dept. of Radiation Oncology, University Medical Center Utrecht, The Netherlands. [Albert MH] Dept. of Pediatrics, Dr. von Hauner Children’s Hospital, University Hospital, LMU Munich, Germany. [Mico Milla S] Servei d’Oncologia Radioteràpica, Vall d'Hebron Hospital Universitari, Barcelona, Spain
Vall d'Hebron Barcelona Hospital Campus
2022-09-12T08:33:02Z
2022-09-12T08:33:02Z
2022-08
Consensus recommendations; Pediatric; Total Body Irradiation
Recomanacions de consens; Pediatria; Irradiació corporal total
Recomendaciones de consenso; Pediatría; Irradiación corporal total
Background and purpose Myeloablative Total Body Irradiation (TBI) is an important modality in conditioning for allogeneic hematopoietic stem cell transplantation (HSCT), especially in children with high-risk acute lymphoblastic leukemia (ALL). TBI practices are heterogeneous and institution-specific. Since TBI is associated with multiple late adverse effects, recommendations may help to standardize practices and improve the outcome versus toxicity ratio for children. Material and methods The European Society for Paediatric Oncology (SIOPE) Radiotherapy TBI Working Group together with ESTRO experts conducted a literature search and evaluation regarding myeloablative TBI techniques and toxicities in children. Findings were discussed in bimonthly virtual meetings and consensus recommendations were established. Results Myeloablative TBI in HSCT conditioning is mostly performed for high-risk ALL patients or patients with recurring hematologic malignancies. TBI is discouraged in children <3–4 years old because of increased toxicity risk. Publications regarding TBI are mostly retrospective studies with level III–IV evidence. Preferential TBI dose in children is 12–14.4 Gy in 1.6–2 Gy fractions b.i.d. Dose reduction should be considered for the lungs to <8 Gy, for the kidneys to ≤10 Gy, and for the lenses to <12 Gy, for dose rates ≥6 cGy/min. Highly conformal techniques i.e. TomoTherapy and VMAT TBI or Total Marrow (and/or Lymphoid) Irradiation as implemented in several centers, improve dose homogeneity and organ sparing, and should be evaluated in studies. Conclusions These ESTRO ACROP SIOPE recommendations provide expert consensus for conventional and highly conformal myeloablative TBI in children, as well as a supporting literature overview of TBI techniques and toxicities.
Article
Published version
English
Infants; Cèl·lules mare hematopoètiques - Trasplantació - Complicacions; Radioteràpia; ANALYTICAL, DIAGNOSTIC AND THERAPEUTIC TECHNIQUES, AND EQUIPMENT::Therapeutics::Biological Therapy::Cell- and Tissue-Based Therapy::Cell Transplantation::Stem Cell Transplantation::Hematopoietic Stem Cell Transplantation; Other subheadings::Other subheadings::Other subheadings::/adverse effects; ANALYTICAL, DIAGNOSTIC AND THERAPEUTIC TECHNIQUES, AND EQUIPMENT::Therapeutics::Radiotherapy::Whole-Body Irradiation; NAMED GROUPS::Persons::Age Groups::Child::Child, Preschool; TÉCNICAS Y EQUIPOS ANALÍTICOS, DIAGNÓSTICOS Y TERAPÉUTICOS::terapéutica::terapia biológica::tratamientos basados en células y tejidos::trasplante de células::trasplante de células madre::trasplante de células madre hematopoyéticas; Otros calificadores::Otros calificadores::Otros calificadores::/efectos adversos; TÉCNICAS Y EQUIPOS ANALÍTICOS, DIAGNÓSTICOS Y TERAPÉUTICOS::terapéutica::radioterapia::irradiación corporal total; DENOMINACIONES DE GRUPOS::personas::Grupos de Edad::niño::niño preescolar
Elsevier
Radiotherapy and Oncology;173
https://doi.org/10.1016/j.radonc.2022.05.027
Attribution 4.0 International
http://creativecommons.org/licenses/by/4.0/
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