20 years of experience in static intensity-modulated total-body irradiation and lung toxicity. Results in 257 consecutive patients.
OBJECTIVE
To analyze lung complications after allogeneic or autologous transplantation following total-body irradiation (TBI) with compensators, so-called sIMRT (static intensity-modulated radiotherapy).


METHODS
Between 1983 and 1998, 257 patients with different hematologic malignancies underwent TBI in six fractions to a total dose of 12 Gy within 3 consecutive days (212 with 11 Gy lung dose) prior to allogeneic (n=174) or autologous (n=83) transplantation. 40 patients were <16 years of age. Minimum follow-up time was 5 years. Median follow-up period was 110 months (13-231 months).


RESULTS
5-year survival rate was 47.9%, 5-year tumor-related mortality 23%, 5-year treatment-related mortality 29.2% (12 Gy lung dose: 53.3%+/-14.6%, 11 Gy: 24.1%+/-5.7%). Interstitial pneumonitis (IP) developed in 28 of 257 patients (10.9% +/- 3.8%). IP incidences in the allogeneic and autologous groups were 14.4% (+/-5.6%) and 3.6% (0-7.6%), respectively. IP incidences with 12/11 Gy lung dose were 22% (+/-12%)/8.5% (+/-3.7%). IP mortality was 9.3% (+/-3.6%). 13 of 28 patients with IP had a cytomegalovirus infection, five an acute graft-versus-host disease grade IV of the lungs. IP incidences with 12/11 Gy lung dose were 25% (9-50%)/4.2% (0.2-19.1%) in patients <16 years, and 20.7% (9.4-37.4%) and 13.3% (+/-6.5%) in older patients after allogeneic transplantation.


CONCLUSIONS
Compensator-generated static intensity-modulated TBI with a total dose of 12 Gy and a lung dose of 11 Gy is a modern and comfortable treatment with moderate lung toxicity, small dose inhomogeneities and little setup failure before transplantation. Especially patients <16 years of age benefit from lung dose reduction.
Schneider
Ralf A
RA
Department of Radiotherapy (Radiation Oncology), University Hospital of Schleswig-Holstein, Campus Kiel (UHK), Kiel, Germany.
Schultze
Jürgen
J
Jensen
Johannes M
JM
Hebbinghaus
Dieter
D
Galalae
Razvan
R
Kimmig
Bernhard N
BN
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000367:Age Factors; D002648:Child; D002908:Chronic Disease; D016001:Confidence Intervals; D003586:Cytomegalovirus Infections / Q000453:epidemiology; D019583:Dose Fractionation, Radiation; D005260:Female; D005500:Follow-Up Studies; D006086:Graft vs Host Disease / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008168:Lung / Q000528:radiation effects*; D017563:Lung Diseases, Interstitial / Q000453:epidemiology* / Q000401:mortality; D016040:Lung Transplantation / Q000401:mortality; D008297:Male; D017564:Radiation Pneumonitis / Q000453:epidemiology* / Q000401:mortality; D011879:Radiotherapy Dosage; D050397:Radiotherapy, Intensity-Modulated / Q000379:methods; D012131:Respiratory Insufficiency / Q000453:epidemiology; D012307:Risk Factors; D013997:Time Factors; D014182:Transplantation, Autologous; D014184:Transplantation, Homologous; D014916:Whole-Body Irradiation / Q000009:adverse effects