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Pulmonary toxicity following total body irradiation for acute lymphoblastic leukaemia: The Ottawa Hospital Cancer Centre (TOHCC) experience

Published online by Cambridge University Press:  02 November 2015

R. K. Ujaimi ,
N. Isfahanian ,
D. J. La Russa ,
R. Samant ,
C. Bredeson  and
P. Genest
R. K. Ujaimi*
Affiliation:
The Radiation Medicine Program, The Ottawa Hospital Cancer Centre, Ottawa, ON, Canada King Abdulaziz University, Jeddah, Saudi Arabia
N. Isfahanian
Affiliation:
The Radiation Medicine Program, The Ottawa Hospital Cancer Centre, Ottawa, ON, Canada
D. J. La Russa
Affiliation:
The Radiation Medicine Program, The Ottawa Hospital Cancer Centre, Ottawa, ON, Canada
R. Samant
Affiliation:
The Radiation Medicine Program, The Ottawa Hospital Cancer Centre, Ottawa, ON, Canada
C. Bredeson
Affiliation:
Blood and Bone Marrow Transplant Program, The Ottawa Hospital, Ottawa, ON, Canada
P. Genest
Affiliation:
The Radiation Medicine Program, The Ottawa Hospital Cancer Centre, Ottawa, ON, Canada
*
Correspondence to: Dr Reem Ujaimi, Faculty of Medicine, Division of Radiation Oncology, University of Ottawa, Ed Smyth Road, Ottawa, ON, K1H 8L6 Canada. Tel: 613-737-7700, ext. 70196; Fax: 613-247-3511; E-mail: ujaimireem@yahoo.com
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Abstract

Purpose

To review the incidence of clinically significant pulmonary toxicity following total body irradiation (TBI) as a part of the conditioning regimen for acute lymphoblastic leukaemia (ALL) patients undergoing bone marrow transplantation (BMT) at The Ottawa Hospital Cancer Centre.

Methods

This is a retrospective review of ALL patients who received TBI in The Ottawa Hospital Bone Marrow Transplant Program (TOH-BMT) as part of their conditioning regimen from 1991 to 2011 inclusive. The patients were treated using a locally developed translating-couch irradiation technique. We have analysed all available data for the first 100 days following TBI to determine the incidence of radiation-induced pulmonary toxicities.

Results

Of the total 622 patients undergoing TBI during the specified period, 88 had ALL. Median age at BMT was 30 years and the conditioning regimens varied. A total of 74 (84%) patients received 12 Gy/6 F/BID of TBI. A total of 55 (63%) patients have died, 32 (36%) within the 1st year after BMT. In the 1st year, pulmonary events were reported for 24 (27%) patients, and the follow-up notes were unavailable for seven (8%). Pulmonary toxicities were reported as the cause of death for six patients, five (6%) within the 1st year. It is estimated that the total number of deaths in the 1st year possibly attributed to radiation-induced lung injury was four (4·5%). Eight (9%) patients had symptoms suggestive of non-lethal grade 2–3 radiation-induced pneumonitis.

Conclusions

TBI continues to be an important component of the conditioning regimen for ALL patients undergoing BMT, and the incidence of radiation-induced pulmonary injury, using our technique and lung dose, is comparable to the published literature.

Keywords

ALLpulmonary toxicitytranslated bed techniqueTBI
Type
Original Articles
Information
Journal of Radiotherapy in Practice , Volume 15 , Issue 1 , March 2016 , pp. 54 - 60
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Copyright
© Cambridge University Press 2015 

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