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A dosimetric evaluation of a novel technique using abutted radiation fields for myeloablative total body irradiation

Published online by Cambridge University Press:  14 December 2020

Arun Chairmadurai Open the ORCID record for Arun Chairmadurai [Opens in a new window] ,
Raghul Ramiya Jayabalan ,
Thirumal Mani ,
Abhishek Gulia ,
Hari Mohan Agrawal ,
Rekha Arya ,
Esha Kaul  and
Nivedita Dhingra
Arun Chairmadurai*
Affiliation:
Department of Radiation Oncology, Jaypee Hospital, Noida, India Amity Centre for Radiation Biology, Amity University, Noida, India
Raghul Ramiya Jayabalan
Affiliation:
Department of Radiation Oncology, Jaypee Hospital, Noida, India
Thirumal Mani
Affiliation:
Department of Radiation Oncology, Jaypee Hospital, Noida, India
Abhishek Gulia
Affiliation:
Department of Radiation Oncology, Jaypee Hospital, Noida, India
Hari Mohan Agrawal
Affiliation:
Department of Radiation Oncology, Jaypee Hospital, Noida, India
Rekha Arya
Affiliation:
Department of Radiation Oncology, Jaypee Hospital, Noida, India
Esha Kaul
Affiliation:
Department of Hemato-Oncology (BMT), Jaypee Hospital, Noida, India
Nivedita Dhingra
Affiliation:
Department of Hemato-Oncology (BMT), Jaypee Hospital, Noida, India
*
Author for correspondence: Arun Chairmadurai, Department of Radiation Oncology, Jaypee Hospital, Noida, 201304, India. Tel: +91 9958198500. E-mail: arun2007ceg@gmail.com
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Abstract

Background:

The present study reports myeloablative total body irradiation (TBI) on an isocentrically mounted linac by laying the patient on the floor and management of abutting radiation fields and partial shielding of lungs. Dosimetrical efficacy of this novel technique was evaluated.

Materials and methods:

In this retrospective study, dosimetrical parameters from TBI plans on whole-body CT scans of 46 patients were analysed. The prescribed dose to TBI was 12 Gy in six fractions delivered over a period of 3 days for myeloablative conditioning. TrueBeam STx platform Linac (Varian Medical Systems Inc., Palo Alto, CA, USA) was used to deliver opposing fields. Radiation fields were abutted to form a single large field using an arithmetic formula at source-to-skin-distance of 210 cm.

Results:

Discrepancies in dose calculated by treatment planning system were within 1·6% accuracy, and dose profile at the junction of abutting radiation fields was reproduced within 3·0% accuracy. The real treatment time for each patient was ~30 minutes/fraction. Monitor unit was weighted for multiple sub-fields to achieve dose homogeneity within 5·0% throughout the whole body, and the mean dose to lung was ≤10 Gy.

Conclusion:

Our abutting radiation field technique for myeloablative TBI is feasible in any existing linac bunker. ‘Island-blocking’ is feasible in this technique using multi-leaf collimator. This technique is cost-effective as it does not require any costly equipment than the readily available equipment in any radiotherapy facility. In general, TBI requires laborious planning procedures and spacious linac bunkers; this novel technique has the potential to change previously held notions.

Keywords

abutting radiation fieldsIsland-blocklung shield using multi-leaf collimatormyeloablative conditioningtotal body irradiation
Type
Original Article
Information
Journal of Radiotherapy in Practice , Volume 21 , Issue 2 , June 2022 , pp. 200 - 207
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Copyright
© The Author(s), 2020. Published by Cambridge University Press

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