Towards homogenization of total body irradiation practices in pediatric patients across SIOPE affiliated centers. A survey by the SIOPE radiation oncology working group

• Published in: Radiotherapy and oncology 2021-02, Vol.155, p.113-119
• Main Authors: Hoeben, Bianca A.W., Pazos, Montserrat, Albert, Michael H., Seravalli, Enrica, Bosman, Mirjam E., Losert, Christoph, Boterberg, Tom, Manapov, Farkhad, Ospovat, Inna, Milla, Soraya Mico, Abakay, Candan Demiroz, Engellau, Jacob, Kos, Gregor, Supiot, Stéphane, Bierings, Marc, Janssens, Geert O.
• Format: Article
• Language: English
• Subjects: Child; Hematopoietic Stem Cell Transplantation; Humans; Leukemia; Leukemia, Myeloid, Acute - radiotherapy; Pediatric; Radiation Oncology; Radiotherapy; Stem cell transplantation; TBI; Total body irradiation; Transplantation Conditioning; Whole-Body Irradiation
• ISSN: 0167-8140; 1879-0887
• DOI: 10.1016/j.radonc.2020.10.032

•Myeloablative TBI has regained interest in HSCT conditioning for pediatric ALL.•An e-survey regarding pediatric TBI was sent out to SIOPE affiliated RT departments.•There is a high level of uniformity in fractionation and use of lung shielding.•Practices vary regarding other OAR shielding and use of modern RT techniques.•A SIOPE RT working group will develop international guidelines for pediatric TBI. To reduce relapse risk, Total Body Irradiation (TBI) is part of conditioning regimens for hematopoietic stem cell transplantation (HSCT) in pediatric acute leukemia. The study purpose was to evaluate clinical practices regarding TBI, such as fractionation, organ shielding and delivery techniques, among SIOPE affiliated radiotherapy centers. An electronic survey was sent out to 233 SIOPE affiliated centers, containing 57 questions about clinical practice of TBI. Surveys could be answered anonymously. From over 25 countries, 82 responses were collected. For TBI-performing centers, 40/48 irradiated ≤10 pediatric patients annually (range: 1–2 to >25). Most indications concerned acute lymphoblastic leukemia (ALL) or acute myeloid leukemia (AML). Four different fractionation schedules were used, of which 12 Gy in 6 fractions was applied in 91% for ALL and 86% for AML. Dose reduction to the lungs, mostly to a mean dose of 8–10 Gy, was applied by 28/33 centers for ALL and 19/21 centers for AML, in contrast to much less applied dose reduction to the kidneys (7/33 ALL and 7/21 AML), thyroid (2/33 ALL and 2/21 AML), liver (4/33 ALL and 3/21 AML) and lenses (4/33 ALL and 4/21 AML). Conventional TBI techniques were used by 24/29 responding centers, while 5/29 used advanced optimized planning techniques. Across SIOPE, there is a high level of uniformity in fractionation and use of lung shielding. Practices vary regarding other organs-at-risk shielding and implementation of advanced techniques. A SIOPE radiotherapy working group will be established to define international guidelines for pediatric TBI.