TY  - JOUR
A1  - Sieker, Katharina
A1  - Fleischmann, Maximilian
A1  - Trommel, Martin
A1  - Ramm, Ulla
A1  - Licher, Jörg
A1  - Bug, Gesine
A1  - Martin, Hans
A1  - Serve, Hubert
A1  - Rödel, Claus
A1  - Balermpas, Panagiotis
T1  - Twenty years of experience of a tertiary cancer center in total body irradiation with focus on oncological outcome and secondary malignancies
T2  - Strahlentherapie und Onkologie
N2  - Purpose: Total body irradiation (TBI) is a common part of the myelo- and immuno-ablative conditioning regimen prior to an allogeneic hematopoietic stem cell transplantation (allo-HSCT). Due to concerns regarding acute and long-term complications, there is currently a decline in otherwise successfully established TBI-based conditioning regimens. Here we present an analysis of patient and treatment data with focus on survival and long-term toxicity.
Methods: Patients with hematologic diseases who received TBI as part of their conditioning regimen prior to allo-HSCT at Frankfurt University Hospital between 1997 and 2015 were identified and retrospectively analyzed.
Results: In all, 285 patients with a median age of 45 years were identified. Median radiotherapy dose applied was 10.5 Gy. Overall survival at 1, 2, 5, and 10 years was 72.6, 64.6, 54.4, and 51.6%, respectively. Median follow-up of patients alive was 102 months. The cumulative incidence of secondary malignancies was 12.3% (n = 35), with hematologic malignancies and skin cancer predominating. A TBI dose ≥ 8 Gy resulted in significantly improved event-free (p = 0.030) and overall survival (p = 0.025), whereas a total dose ≤ 8 Gy and acute myeloid leukemia (AML) diagnosis were associated with significantly increased rates of secondary malignancies (p = 0.003, p = 0.048) in univariate analysis. No significant correlation was observed between impaired renal or pulmonary function and TBI dose.
Conclusion: TBI remains an effective and well-established treatment, associated with distinct late-toxicity. However, in the present study we cannot confirm a dose–response relationship in intermediate dose ranges. Survival, occurrence of secondary malignancies, and late toxicities appear to be subject to substantial confounding in this context.
KW  - TBI
KW  - Sequelae
KW  - Toxicity
KW  - Long-term follow-up
KW  - Hematopoietic stem cell transplant
Y1  - 2022
UR  - http://publikationen.ub.uni-frankfurt.de/frontdoor/index/index/docId/69521
UR  - https://nbn-resolving.org/urn:nbn:de:hebis:30:3-695210
SN  - 1439-099X
N1  - Open Access funding enabled and organized by Projekt DEAL.
VL  - 198
IS  - 6
SP  - 547
EP  - 557
PB  - Springer Medizin
CY  - Berlin ; Heidelberg
ER  -