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Twenty years of experience of a tertiary cancer center in total body irradiation with focus on oncological outcome and secondary malignancies.


ABSTRACT:

Purpose

Total body irradiation (TBI) is a common part of the myelo- and immuno-ablative conditioning regimen prior to an allogeneic hematopoietic stem cell transplantation (allo-HSCT). Due to concerns regarding acute and long-term complications, there is currently a decline in otherwise successfully established TBI-based conditioning regimens. Here we present an analysis of patient and treatment data with focus on survival and long-term toxicity.

Methods

Patients with hematologic diseases who received TBI as part of their conditioning regimen prior to allo-HSCT at Frankfurt University Hospital between 1997 and 2015 were identified and retrospectively analyzed.

Results

In all, 285 patients with a median age of 45 years were identified. Median radiotherapy dose applied was 10.5 Gy. Overall survival at 1, 2, 5, and 10 years was 72.6, 64.6, 54.4, and 51.6%, respectively. Median follow-up of patients alive was 102 months. The cumulative incidence of secondary malignancies was 12.3% (n = 35), with hematologic malignancies and skin cancer predominating. A TBI dose ≥ 8 Gy resulted in significantly improved event-free (p = 0.030) and overall survival (p = 0.025), whereas a total dose ≤ 8 Gy and acute myeloid leukemia (AML) diagnosis were associated with significantly increased rates of secondary malignancies (p = 0.003, p = 0.048) in univariate analysis. No significant correlation was observed between impaired renal or pulmonary function and TBI dose.

Conclusion

TBI remains an effective and well-established treatment, associated with distinct late-toxicity. However, in the present study we cannot confirm a dose-response relationship in intermediate dose ranges. Survival, occurrence of secondary malignancies, and late toxicities appear to be subject to substantial confounding in this context.

SUBMITTER: Sieker K 

PROVIDER: S-EPMC9165288 | biostudies-literature | 2022 Jun

REPOSITORIES: biostudies-literature

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Publications

Twenty years of experience of a tertiary cancer center in total body irradiation with focus on oncological outcome and secondary malignancies.

Sieker Katharina K   Fleischmann Maximilian M   Trommel Martin M   Ramm Ulla U   Licher Jörg J   Bug Gesine G   Martin Hans H   Serve Hubert H   Rödel Claus C   Balermpas Panagiotis P  

Strahlentherapie und Onkologie : Organ der Deutschen Rontgengesellschaft ... [et al] 20220322 6


<h4>Purpose</h4>Total body irradiation (TBI) is a common part of the myelo- and immuno-ablative conditioning regimen prior to an allogeneic hematopoietic stem cell transplantation (allo-HSCT). Due to concerns regarding acute and long-term complications, there is currently a decline in otherwise successfully established TBI-based conditioning regimens. Here we present an analysis of patient and treatment data with focus on survival and long-term toxicity.<h4>Methods</h4>Patients with hematologic  ...[more]

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