Total marrow and lymphoid irradiation with helical tomotherapy: a practical implementation report
- Author:
Srinivas CHILUKURI
1
;
Sham SUNDAR
;
Rajesh THIYAGARAJAN
;
Jose EASOW
;
Mayur SAWANT
;
Ganapathy KRISHANAN
;
Pankaj Kumar PANDA
;
Dayananda SHARMA
;
Rakesh JALALI
Author Information
- Publication Type:Original Article
- From:Radiation Oncology Journal 2020;38(3):207-216
- CountryRepublic of Korea
-
Abstract:
Objective:To standardize the technique; evaluate resources requirements and analyze our early experience of total marrow and lymphoid irradiation (TMLI) as part of the conditioning regimen before allogenic bone marrow transplantation using helical tomotherapy.
Methods:Computed tomography (CT) scanning and treatment were performed in head first supine (HFS) and feet first supine (FFS) orientations with an overlap at mid-thigh. Patients along with the immobilization device were manually rotated by 180° to change the orientation after the delivery of HFS plan. The dose at the junction was contributed by a complementary dose gradient from each of the plans. Plan was to deliver 95% of 12 Gy to 98% of clinical target volume with dose heterogeneity <10% and pre-specified organs-at-risk dose constraints. Megavoltage-CT was used for position verification before each fraction. Patient specific quality assurance and in vivo film dosimetry to verify junction dose were performed in all patients.
Results:Treatment was delivered in two daily fractions of 2 Gy each for 3 days with at least 8-hour gap between each fraction. The target coverage goals were met in all the patients. The average person-hours per patient were 16.5, 21.5, and 25.75 for radiation oncologist, radiation therapist, and medical physicist, respectively. Average in-room time per patient was 9.25 hours with an average beam-on time of 3.32 hours for all the 6 fractions.
Conclusion:This report comprehensively describes technique and resource requirements for TMLI and would serve as a practical guide for departments keen to start this service. Despite being time and labor intensive, it can be implemented safely and robustly.
