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Total body irradiation using volumetric modulated arc therapy, experience of a cancer hospital in Pakistan

Published online by Cambridge University Press:  01 August 2022

Tabinda Sadaf Open the ORCID record for Tabinda Sadaf [Opens in a new window] ,
Asma Rashid ,
Waqas Imam Bokhari ,
Eileen Samuel ,
Aqueel Shahid ,
Raheel Mukhtar ,
Umair Zafar  and
Khalid Iqbal
Tabinda Sadaf*
Affiliation:
Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore 54000, Pakistan
Asma Rashid
Affiliation:
Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore 54000, Pakistan
Waqas Imam Bokhari
Affiliation:
Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore 54000, Pakistan
Eileen Samuel
Affiliation:
Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore 54000, Pakistan
Aqueel Shahid
Affiliation:
Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore 54000, Pakistan
Raheel Mukhtar
Affiliation:
Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore 54000, Pakistan
Umair Zafar
Affiliation:
Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore 54000, Pakistan
Khalid Iqbal
Affiliation:
Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore 54000, Pakistan
*
Author for correspondence: Tabinda Sadaf, Shaukat Khanum Memorial Cancer Hospital and Research Centre, MA R3 Johar Town Lahore, Lahore 54000, Pakistan. E-mail: tabinds@skm.orgpk
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Abstract

Introduction:

To report the planning parameters, efficacy and toxicity of total body irradiation using volumetric modulated arc therapy (VMAT).

Methods:

From July 2019 till May 2021, nine patients treated with VMAT-based total body irradiation as a part of the myeloablative regimen for homologous stem cell transplant were evaluated. The CT acquisition, planning parameters, doses to target volume and critical structures were evaluated retrospectively.

Results:

Median age was 24 with median height 172 cm. Average Mean Lung dose was 9·5 Gy, mean dose to kidney was kidney dose 8·4 Gy, planning target volume (PTV) 95% was 98 % and mean heterogeneity index of PTV was 1·2 all patients. Total fraction delivery time including setup was 3·1 h while beam on time was 23 min. Main toxicity observed was mucositis and fatigue, while no Grade 3 or more acute radiation toxicity was observed.

Conclusion:

At our institution, high dose TBI performed with multi-isocentric VMAT is now a standard procedure. Though it is cumbersome and time-consuming process but VMAT offers an advantage of increased dose homogeneity in the target volume with reduction in doses to critical organs especially lungs and kidneys in comparison to standard source to skin distance technique, longer follow-up time is necessary to evaluate our method and long-term toxicity.

Keywords

Total body irradiation (TBI)Volumetric modulated arc therapy (VMAT)Organs at risk (OAR)
Type
Original Article
Information
Journal of Radiotherapy in Practice , Volume 22 , 2023 , e40
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Copyright
© The Author(s), 2022. Published by Cambridge University Press

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