Helical tomotherapy for total lymphoid irradiation
Tóm tắt
Total lymphoid irradiation is employed in the preparative regimens for allogeneic bone marrow and solid organ transplantation, solid organ transplant rejection, and chronic graft-versus-host disease. Linear accelerator-based radiotherapy, typically involving opposed anteroposterior and posteroanterior beams, has been commonly used; however, extended source-to-skin patient setup and/or field matching are required, and all organs within the beam coverage receive the entire prescribed dose. Megavoltage helical tomotherapy represents a technological advance in terms of both treatment delivery and patient positioning. The continuously rotating multileaf collimated fan beam allows highly conformal coverage of complex target geometries, in turn allowing avoidance of radiosensitive adjacent organs. In addition, the megavoltage computed tomographic scans allow potentially more accurate, targetbased setup verification. The present case report describes tomotherapy-based total lymphoid irradiation in an adult patient with late-onset cardiac transplant rejection. Treatment planning allowed dose minimization to the spinal cord, kidneys, intestinal compartment, and lungs. The patient tolerated treatment well without acute adverse effects, and he is now in early follow-up.
Tài liệu tham khảo
Gluckman E, Socie G, Devergie A, Bourdeau-Esperou H, Traineau R, Cosset JM. Bone marrow transplantation in 107 patients with severe aplastic anemia using cyclophosphamide and thoraco-abdominal irradiation for conditioning: longterm follow-up. Blood 1991;78:2451–2455.
Moudgil A, Puliyanda D. Induction therapy in pediatric renal transplant recipients: an overview. Pediatr Drugs 2007;9:323–341.
Trachiotis GD, Johnston TS, Vega JD, Crocker IR, Chesnut N, Lutz JF, et al. Single-field total lymphoid irradiation in the treatment of refractory rejection after heart transplantation. J Heart Lung Transplant 1998;17:1045–1048.
Keogh AM, Arnold RH, Macdonald PS, Hawkins RC, Morgan GW, Spratt PM. A randomized trial of tacrolimus (FK506) versus total lymphoid irradiation for the control of repetitive rejection after cardiac transplantation. J Heart Lung Transplant 2001;20:1331–1334.
Ross HJ, Gullestad L, Pak J, Slauson S, Valantine HA, Hunt SA. Methotrexate or total lymphoid radiation for treatment of persistent or recurrent allograft cellular rejection: a comparative study. J Heart Lung Transplant 1997;16:179–189.
Wolden SL, Tate DJ, Hunt SA, Strober S, Hoppe RT. Longterm results of total lymphoid irradiation in the treatment of cardiac allograft rejection. Int J Radiat Oncol Biol Phys 2002;21:953–960.
Salter SP, Salter MM, Kirklin JK, Bourge RC, Naftel DC. Total lymphoid irradiation in the treatment of early or recurrent heart transplant rejection. Int J Radiat Oncol Biol Phys 1995;33:83–87.
Madden BP, Barros J, Backhouse L, Stamenkovic S, Tait D, Murday A. Intermediate term results of total lymphoid irradiation for the treatment of non-specific graft dysfunction after heart transplantation. Eur J Cardiothorac Surg 1999;15:663–666.
Chin C, Hunt S, Robbins R, Hoppe R, Reitz B, Bernstein D. Long-term follow-up after total lymphoid irradiation in pediatric heart transplant recipients. J Heart Lung Transplant 2002;21:667–673.
Lim TS, O’Driscoll G, Freund J, Peterson V, Hayes H, Heywood J. Short-course total lymphoid irradiation for refractory cardiac transplantation rejection. J Heart Lung Transplant 2007;26:1249–1254.
Valentine VG, Robbins RC, Wehner JH, Patel HR, Berry GJ, Theodore J. Total lymphoid irradiation for refractory acute rejection in heart-lung and lung allografts. Chest 1996;109:1184–1189.
Diamond DA, Michalski JM, Lynch JP, Truluck EP. Efficacy of total lymphoid irradiation for chronic allograft rejection following bilateral lung transplantation. Int J Radiat Oncol Biol Phys 1998;41:795–800.
Robin M, Guardiola P, Girinsky T, Hernandez G, Esperou H, Ribaud P, et al. Low-dose thoracoabdominal irradiation for the treatment of refractory chronic graft-versus-host disease. Transplantation 2005;80:634–642.
Heinzelmann F, Lang PJ, Ottinger H, Faul C, Bethge W, Handgretinger R, et al. Immunosuppressive total lymphoid irradiation-based reconditioning regimens enable engraftment after graft rejection or graft failure in patients treated with allogeneic hematopoietic stem cell transplantation. Int J Radiat Oncol Biol Phys 2008;70:523–528.
Beavis AW. Is tomotherapy the future of IMRT? Br J Radiol 2004;77:285–295.
Schultheiss TE, Wong J, Liu A, Olivera G, Somlo G. Imageguided total marrow and total lymphatic irradiation using helical tomotherapy. Int J Radiat Oncol Biol Phys 2007;67:1259–1267.
Marks LB, Ma J. Challenges in the clinical application of advanced technologies to reduce radiation-associated normal tissue injury. Int J Radiat Oncol Biol Phys 2007;69:4–12.