title: Long-term outcome after static intensity-modulated total body radiotherapy using compensators stratified by pediatric and adult cohorts.
abstract: OBJECTIVE
  To report the long-term outcome after total body irradiation with intensity-modulating compensators and allogeneic/autologous transplantation, especially in terms of therapy-related toxicity in pediatric and adult cohorts.
  
  
  METHODS
  A total of 257 consecutive patients (40 children and 217 adults) have been treated since 1983 with TBI using static intensity-modulated radiotherapy for hematologic malignancies. The total dose of 12 Gy was applied in six fractions within 3 days before allogeneic (n = 174) or autologous (n = 83) transplantation. The median follow-up was 9.2 years.
  
  
  RESULTS
  The 5-year overall survival rate was 47.9% (49.8% for the adults and 37.5% for the children, p = 0.171). The 5-year tumor-related mortality rate was 23%, and the 5-year treatment-related mortality rate 29.2% (29.5% in the adults and 27.5% in the pediatric patients). Interstitial pneumonitis developed in 28 (10.9%) of 257 patients and in 12.5% of the pediatric cohort. The interstitial pneumonitis rate was 25% in pediatric patients treated with a 12-Gy lung dose compared with 4.2% for those treated to an 11-Gy lung dose. The overall survival rate stratified by lung dose was 26.7% for 12 Gy and 52.4% for 11 Gy (p = 0.001). The incidence of veno-occlusive disease and cataract was 5.8% and 6.6% in all patients and 12.5% and 15% in the pediatric patients, respectively (p < 0.05). Secondary malignancies were found in 4.3% of all patients, all in the adult cohort at transplantation.
  
  
  CONCLUSIONS
  Static intensity-modulated total body irradiation with a total dose of 12 Gy before allogeneic/autologous transplantation is a successful treatment with good long-term outcome and acceptable therapy-related toxicities. Constraining the lung dose to 11 Gy substantially lowered the actuarial treatment-related mortality. This effect was especially striking in the pediatric patients.
authors.affiliation: Rinecker Proton Therapy Center, München, Germany. ralf.schneider@rptc-1.de
authors.forename: Ralf A
authors.initials: RA
authors.lastname: Schneider
authors.forename: Juergen
authors.initials: J
authors.lastname: Schultze
authors.forename: J Martin
authors.initials: JM
authors.lastname: Jensen
authors.forename: Dieter
authors.initials: D
authors.lastname: Hebbinghaus
authors.forename: Razvan M
authors.initials: RM
authors.lastname: Galalae
mesh_terms: D000293:Adolescent; D000328:Adult; D001842:Bone and Bones / Q000528:radiation effects; D001921:Brain / Q000528:radiation effects; D002386:Cataract / Q000209:etiology; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D005260:Female; D006086:Graft vs Host Disease / Q000209:etiology; D006130:Growth Disorders / Q000209:etiology; D019337:Hematologic Neoplasms / Q000401:mortality / Q000532:radiotherapy*; D006801:Humans; D021621:Imaging, Three-Dimensional; D007668:Kidney / Q000528:radiation effects; D008297:Male; D008875:Middle Aged; D009381:Neoplasms, Radiation-Induced / Q000209:etiology; D017564:Radiation Pneumonitis / Q000175:diagnosis; D011879:Radiotherapy Dosage; D050397:Radiotherapy, Intensity-Modulated / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D019172:Transplantation Conditioning; D016896:Treatment Outcome; D014916:Whole-Body Irradiation / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*