Outcomes of allogeneic haematopoietic stem cell transplantation with intensity-modulated total body irradiation by helical tomotherapy: a 2-year prospective follow-up study.

BACKGROUND AND OBJECTIVES: Intensity-modulated radiation therapy (IMRT) helps achieve good radiation dose conformity and precise dose evaluation. We conducted a single-centre prospective study to assess the safety and feasibility of total body irradiation with IMRT (IMRT-TBI) using helical tomotherapy in allogeneic haematopoietic stem cell transplantation (allo-HSCT). PATIENTS AND METHODS: Thirty-nine adult patients with haematological malignancy (acute lymphoblastic leukaemia [n = 21], chronic myeloid leukaemia [n = 6], mixed phenotype acute leukaemia [n = 5], acute myeloid leukaemia [n = 4], and malignant lymphoma [n = 3]) who received 12 Gy IMRT-TBI were enrolled with a median follow-up of 934.5 (range, 617-1254) d. At the time of transplantation, 33 patients (85%) achieved complete remission. The conditioning regimen used IMRT-TBI (12 Gy in 6 fractions twice daily, for 3 d) and cyclophosphamide (60 mg/kg/d, for 2 d), seven patients were combined with cytarabine, and five with etoposide. We set dose constraints for the lungs, kidneys and lens as the organs at risk. RESULTS: The mean doses for the lungs and kidneys were 7.50 and 9.11 Gy, respectively. The mean maximum dose for the lens (right/left) was 5.75/5.87 Gy. The 2-year overall survival (OS), disease-free survival (DFS), cumulative incidence of relapse (CIR) and non-relapse mortality (NRM) were 69, 64, 18 and 18%, respectively. Thirty-six patients developed early adverse events (AEs) (including four patients with Grade 3/4 toxicities), most of which were reversible oral mucositis and may partially have been related to IMRT-TBI. However, the incidence of toxicity was comparable to conventional TBI-based conditioning transplantation. None of the patients developed primary graft failure, or Grade III-IV acute graft-versus-host disease (GVHD). In late complications, chronic kidney disease was observed in six patients, a lower incidence compared to conventional TBI-based conditioning transplantation. No radiation pneumonitis or cataracts were observed in any of the patients. CONCLUSIONS: IMRT-TBI is safe and feasible for haematological malignancies with acceptable clinical outcomes.KEY MESSAGESIMRT-TBI-helical tomotherapy aids in accurate dose calculation and conformity.It could be used without any considerable increase in the rate of TBI-related AEs.Allo-HSCT with IMRT-TBI may be an alternative to conventional TBI for clinical use.

Safety of total body irradiation using intensity-modulated radiation therapy by helical tomotherapy in allogeneic hematopoietic stem cell transplantation: a prospective pilot study.

Total body irradiation using intensity-modulated radiation therapy total body irradiation (IMRT-TBI) by helical tomotherapy in allogeneic hematopoietic stem cell transplantation (allo-HSCT) allows for precise evaluation and adjustment of radiation dosage. We conducted a single-center pilot study to evaluate the safety of IMRT-TBI for allo-HSCT recipients. Patients with hematological malignancies in remission who were scheduled for allo-HSCT with TBI-based myeloablative conditioning were eligible. The primary endpoint was the incidence of adverse events (AEs). Secondary endpoints were engraftment rate, overall survival, relapse rate, non-relapse mortality, and the incidence of acute and chronic graft-versus-host disease (aGVHD and cGVHD, respectively). Between July 2018 and November 2018, ten patients were recruited with a median observation duration of 571 days after allo-HSCT (range, 496-614). D80% for planning target volume (PTV) in all patients was 12.01 Gy. Average D80% values for lungs, kidneys and lenses (right/left) were 7.50, 9.03 and 4.41/4.03 Gy, respectively. Any early AEs (within 100 days of allo-HSCT) were reported in all patients. Eight patients experienced oral mucositis and gastrointestinal symptoms. One patient experienced Bearman criteria grade 3 regimen-related toxicity (kidney and liver). All cases achieved neutrophil engraftment. There was no grade III-IV aGVHD or late AE. One patient died of sinusoidal obstruction syndrome 67 days after allo-HSCT. The remaining nine patients were alive and disease-free at final follow-up. Thus, IMRT-TBI was well tolerated in terms of early AEs in adult patients who underwent allo-HSCT; this warrants further study with longer observation times to monitor late AEs and efficacy.

Rectal Toxicity After Extremely Hypofractionated Radiotherapy Using a Non-Isocentric Robotic Radiosurgery System for Early Stage Prostate Cancer.

BACKGROUND: The aim of the study was to evaluate toxicity after extremely hypofractionated radiotherapy (EHF-RT) using a non-isocentric robotic radiosurgery system for early stage prostate cancer. METHODS: Eligibility criteria of this feasibility study were 50 - 84 years old, and low-risk to intermediate-risk disease. The prescribed dose to the iso-dose line of 95% of planning target volume was 35 Gy in five fractions over 2 weeks. The primary endpoint was the incidence of ≥ grade 2 acute toxicity which indicated symptoms requiring medications. RESULTS: We enrolled 20 patients from December 2012 to August 2014, and the median follow-up time was 30 months (range: 18 - 36). Sixteen patients had a short overall treatment time (OTT) of EHF-RT (9 - 10 days), and four patients had a long OTT (11 - 12 days) because of national holidays and patient's preference. The incidences of ≥ grade 2 acute toxicity in all sites, that in the rectum, and that in the genitourinary system, were 30%, 20%, and 10%, respectively. No patient developed severe acute toxicity (≥ grade 3). Among 16 patients with a short OTT of EHF-RT, four patients developed grade 2 acute rectal toxicity. Rectum-V28 Gy (rectal volume receiving ≥ 28 Gy) of 3.8 mL or higher had a tendency to increase grade 2 acute rectal toxicity (P = 0.058). One patient developed grade 3 late rectal toxicity and no patient developed severe late genitourinary toxicity. CONCLUSION: The incidences of ≥ grade 2 acute toxicity in all sites and that in the rectum after EHF-RT of 35 Gy in five fractions were 30% and 20%, respectively. High rectum-V28 Gy was associated with grade 2 acute rectal toxicity after EHF-RT for early prostate cancer.

[Conservative treatments for fracture repair].

Conservative treatments for fractures are basic technique. We introduced the basic concepts of following methods:bandage, plaster casting, traction, cast-brace, pinning and external fixation. Then we summarized the indications of these techniques.