ESTRO ACROP and SIOPE recommendations for myeloablative Total Body Irradiation in children

Bianca A W Hoeben; Montserrat Pazos; Enrica Seravalli; Mirjam E Bosman; Christoph Losert; Michael H Albert; Tom Boterberg; Inna Ospovat; Soraya Mico Milla; Candan Demiroz Abakay; Jacob Engellau; Vilberg Jóhannesson; Gregor Kos; Stéphane Supiot; Camille Llagostera; Marc Bierings; Giovanni Scarzello; Klaus Seiersen; Ed Smith; Abrahams Ocanto; Carlos Ferrer; Søren M Bentzen; Daria A Kobyzeva; Anna A Loginova; Geert O Janssens

doi:10.1016/j.radonc.2022.05.027

ESTRO ACROP and SIOPE recommendations for myeloablative Total Body Irradiation in children

Bianca A W Hoeben, Montserrat Pazos, Enrica Seravalli, Mirjam E Bosman, Christoph Losert, Michael H Albert, Tom Boterberg, Inna Ospovat, Soraya Mico Milla, Candan Demiroz Abakay, Jacob Engellau, Vilberg Jóhannesson, Gregor Kos, Stéphane Supiot, Camille Llagostera, Marc Bierings, Giovanni Scarzello, Klaus Seiersen, Ed Smith, Abrahams OcantoCarlos Ferrer, Søren M Bentzen, Daria A Kobyzeva, Anna A Loginova, Geert O Janssens

Skåne University Hospital

Forskningsoutput: Tidskriftsbidrag › Artikel i vetenskaplig tidskrift › Peer review

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BACKGROUND AND PURPOSE: Myeloablative Total Body Irradiation (TBI) is an important modality in conditioning for allogeneic hematopoietic stem cell transplantation (HSCT), especially in children with high-risk acute lymphoblastic leukemia (ALL). TBI practices are heterogeneous and institution-specific. Since TBI is associated with multiple late adverse effects, recommendations may help to standardize practices and improve the outcome versus toxicity ratio for children.

MATERIAL AND METHODS: The European Society for Paediatric Oncology (SIOPE) Radiotherapy TBI Working Group together with ESTRO experts conducted a literature search and evaluation regarding myeloablative TBI techniques and toxicities in children. Findings were discussed in bimonthly virtual meetings and consensus recommendations were established.

RESULTS: Myeloablative TBI in HSCT conditioning is mostly performed for high-risk ALL patients or patients with recurring hematologic malignancies. TBI is discouraged in children <3-4 years old because of increased toxicity risk. Publications regarding TBI are mostly retrospective studies with level III-IV evidence. Preferential TBI dose in children is 12-14.4 Gy in 1.6-2 Gy fractions b.i.d. Dose reduction should be considered for the lungs to <8 Gy, for the kidneys to ≤10 Gy, and for the lenses to <12 Gy, for dose rates ≥6 cGy/min. Highly conformal techniques i.e. TomoTherapy and VMAT TBI or Total Marrow (and/or Lymphoid) Irradiation as implemented in several centers, improve dose homogeneity and organ sparing, and should be evaluated in studies.

CONCLUSIONS: These ESTRO ACROP SIOPE recommendations provide expert consensus for conventional and highly conformal myeloablative TBI in children, as well as a supporting literature overview of TBI techniques and toxicities.

Originalspråk	engelska
Sidor (från-till)	119-133
Tidskrift	Radiotherapy and Oncology
Volym	173
DOI	https://doi.org/10.1016/j.radonc.2022.05.027
Status	Published - 2022 aug.
Externt publicerad	Ja

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Hoeben, B. A. W., Pazos, M., Seravalli, E., Bosman, M. E., Losert, C., Albert, M. H., Boterberg, T., Ospovat, I., Mico Milla, S., Demiroz Abakay, C., Engellau, J., Jóhannesson, V., Kos, G., Supiot, S., Llagostera, C., Bierings, M., Scarzello, G., Seiersen, K., Smith, E., ... Janssens, G. O. (2022). ESTRO ACROP and SIOPE recommendations for myeloablative Total Body Irradiation in children. Radiotherapy and Oncology, 173, 119-133. https://doi.org/10.1016/j.radonc.2022.05.027

@article{d4b2f96ca00549a6b1290f99152eb704,

title = "ESTRO ACROP and SIOPE recommendations for myeloablative Total Body Irradiation in children",

abstract = "BACKGROUND AND PURPOSE: Myeloablative Total Body Irradiation (TBI) is an important modality in conditioning for allogeneic hematopoietic stem cell transplantation (HSCT), especially in children with high-risk acute lymphoblastic leukemia (ALL). TBI practices are heterogeneous and institution-specific. Since TBI is associated with multiple late adverse effects, recommendations may help to standardize practices and improve the outcome versus toxicity ratio for children.MATERIAL AND METHODS: The European Society for Paediatric Oncology (SIOPE) Radiotherapy TBI Working Group together with ESTRO experts conducted a literature search and evaluation regarding myeloablative TBI techniques and toxicities in children. Findings were discussed in bimonthly virtual meetings and consensus recommendations were established.RESULTS: Myeloablative TBI in HSCT conditioning is mostly performed for high-risk ALL patients or patients with recurring hematologic malignancies. TBI is discouraged in children <3-4 years old because of increased toxicity risk. Publications regarding TBI are mostly retrospective studies with level III-IV evidence. Preferential TBI dose in children is 12-14.4 Gy in 1.6-2 Gy fractions b.i.d. Dose reduction should be considered for the lungs to <8 Gy, for the kidneys to ≤10 Gy, and for the lenses to <12 Gy, for dose rates ≥6 cGy/min. Highly conformal techniques i.e. TomoTherapy and VMAT TBI or Total Marrow (and/or Lymphoid) Irradiation as implemented in several centers, improve dose homogeneity and organ sparing, and should be evaluated in studies.CONCLUSIONS: These ESTRO ACROP SIOPE recommendations provide expert consensus for conventional and highly conformal myeloablative TBI in children, as well as a supporting literature overview of TBI techniques and toxicities.",

keywords = "Bone Marrow, Child, Child, Preschool, Hematopoietic Stem Cell Transplantation/adverse effects, Humans, Retrospective Studies, Transplantation Conditioning/methods, Whole-Body Irradiation/adverse effects",

author = "Hoeben, {Bianca A W} and Montserrat Pazos and Enrica Seravalli and Bosman, {Mirjam E} and Christoph Losert and Albert, {Michael H} and Tom Boterberg and Inna Ospovat and {Mico Milla}, Soraya and {Demiroz Abakay}, Candan and Jacob Engellau and Vilberg J{\'o}hannesson and Gregor Kos and St{\'e}phane Supiot and Camille Llagostera and Marc Bierings and Giovanni Scarzello and Klaus Seiersen and Ed Smith and Abrahams Ocanto and Carlos Ferrer and Bentzen, {S{\o}ren M} and Kobyzeva, {Daria A} and Loginova, {Anna A} and Janssens, {Geert O}",

year = "2022",

month = aug,

doi = "10.1016/j.radonc.2022.05.027",

language = "English",

volume = "173",

pages = "119--133",

journal = "Radiotherapy and Oncology",

issn = "1879-0887",

publisher = "Elsevier",

}

Hoeben, BAW, Pazos, M, Seravalli, E, Bosman, ME, Losert, C, Albert, MH, Boterberg, T, Ospovat, I, Mico Milla, S, Demiroz Abakay, C, Engellau, J , Jóhannesson, V, Kos, G, Supiot, S, Llagostera, C, Bierings, M, Scarzello, G, Seiersen, K, Smith, E, Ocanto, A, Ferrer, C, Bentzen, SM, Kobyzeva, DA, Loginova, AA & Janssens, GO 2022, 'ESTRO ACROP and SIOPE recommendations for myeloablative Total Body Irradiation in children', Radiotherapy and Oncology, vol. 173, s. 119-133. https://doi.org/10.1016/j.radonc.2022.05.027

TY - JOUR

T1 - ESTRO ACROP and SIOPE recommendations for myeloablative Total Body Irradiation in children

AU - Hoeben, Bianca A W

AU - Pazos, Montserrat

AU - Seravalli, Enrica

AU - Bosman, Mirjam E

AU - Losert, Christoph

AU - Albert, Michael H

AU - Boterberg, Tom

AU - Ospovat, Inna

AU - Mico Milla, Soraya

AU - Demiroz Abakay, Candan

AU - Engellau, Jacob

AU - Jóhannesson, Vilberg

AU - Kos, Gregor

AU - Supiot, Stéphane

AU - Llagostera, Camille

AU - Bierings, Marc

AU - Scarzello, Giovanni

AU - Seiersen, Klaus

AU - Smith, Ed

AU - Ocanto, Abrahams

AU - Ferrer, Carlos

AU - Bentzen, Søren M

AU - Kobyzeva, Daria A

AU - Loginova, Anna A

AU - Janssens, Geert O

PY - 2022/8

Y1 - 2022/8

N2 - BACKGROUND AND PURPOSE: Myeloablative Total Body Irradiation (TBI) is an important modality in conditioning for allogeneic hematopoietic stem cell transplantation (HSCT), especially in children with high-risk acute lymphoblastic leukemia (ALL). TBI practices are heterogeneous and institution-specific. Since TBI is associated with multiple late adverse effects, recommendations may help to standardize practices and improve the outcome versus toxicity ratio for children.MATERIAL AND METHODS: The European Society for Paediatric Oncology (SIOPE) Radiotherapy TBI Working Group together with ESTRO experts conducted a literature search and evaluation regarding myeloablative TBI techniques and toxicities in children. Findings were discussed in bimonthly virtual meetings and consensus recommendations were established.RESULTS: Myeloablative TBI in HSCT conditioning is mostly performed for high-risk ALL patients or patients with recurring hematologic malignancies. TBI is discouraged in children <3-4 years old because of increased toxicity risk. Publications regarding TBI are mostly retrospective studies with level III-IV evidence. Preferential TBI dose in children is 12-14.4 Gy in 1.6-2 Gy fractions b.i.d. Dose reduction should be considered for the lungs to <8 Gy, for the kidneys to ≤10 Gy, and for the lenses to <12 Gy, for dose rates ≥6 cGy/min. Highly conformal techniques i.e. TomoTherapy and VMAT TBI or Total Marrow (and/or Lymphoid) Irradiation as implemented in several centers, improve dose homogeneity and organ sparing, and should be evaluated in studies.CONCLUSIONS: These ESTRO ACROP SIOPE recommendations provide expert consensus for conventional and highly conformal myeloablative TBI in children, as well as a supporting literature overview of TBI techniques and toxicities.

AB - BACKGROUND AND PURPOSE: Myeloablative Total Body Irradiation (TBI) is an important modality in conditioning for allogeneic hematopoietic stem cell transplantation (HSCT), especially in children with high-risk acute lymphoblastic leukemia (ALL). TBI practices are heterogeneous and institution-specific. Since TBI is associated with multiple late adverse effects, recommendations may help to standardize practices and improve the outcome versus toxicity ratio for children.MATERIAL AND METHODS: The European Society for Paediatric Oncology (SIOPE) Radiotherapy TBI Working Group together with ESTRO experts conducted a literature search and evaluation regarding myeloablative TBI techniques and toxicities in children. Findings were discussed in bimonthly virtual meetings and consensus recommendations were established.RESULTS: Myeloablative TBI in HSCT conditioning is mostly performed for high-risk ALL patients or patients with recurring hematologic malignancies. TBI is discouraged in children <3-4 years old because of increased toxicity risk. Publications regarding TBI are mostly retrospective studies with level III-IV evidence. Preferential TBI dose in children is 12-14.4 Gy in 1.6-2 Gy fractions b.i.d. Dose reduction should be considered for the lungs to <8 Gy, for the kidneys to ≤10 Gy, and for the lenses to <12 Gy, for dose rates ≥6 cGy/min. Highly conformal techniques i.e. TomoTherapy and VMAT TBI or Total Marrow (and/or Lymphoid) Irradiation as implemented in several centers, improve dose homogeneity and organ sparing, and should be evaluated in studies.CONCLUSIONS: These ESTRO ACROP SIOPE recommendations provide expert consensus for conventional and highly conformal myeloablative TBI in children, as well as a supporting literature overview of TBI techniques and toxicities.

KW - Bone Marrow

KW - Child

KW - Child, Preschool

KW - Hematopoietic Stem Cell Transplantation/adverse effects

KW - Humans

KW - Retrospective Studies

KW - Transplantation Conditioning/methods

KW - Whole-Body Irradiation/adverse effects

U2 - 10.1016/j.radonc.2022.05.027

DO - 10.1016/j.radonc.2022.05.027

M3 - Article

C2 - 35661674

SN - 1879-0887

VL - 173

SP - 119

EP - 133

JO - Radiotherapy and Oncology

JF - Radiotherapy and Oncology

ER -

ESTRO ACROP and SIOPE recommendations for myeloablative Total Body Irradiation in children

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