Trial reportInternational journal of radiation oncology, biology, physics2019
Higher Reported Lung Dose Received During Total Body Irradiation for Allogeneic Hematopoietic Stem Cell Transplantation in Children With Acute Lymphoblastic Leukemia Is Associated With Inferior Survival: A Report from the Children's Oncology Group.
Trial report in International journal of radiation oncology, biology, physics, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 28 papers.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
28 citing papers in PubMed, 58 citations in OpenAlex.
- Feasibility study of total marrow lymphoid irradiation with volumetric modulated arc therapy: clinical implementation in a tertiary care center.Strahlentherapie und Onkologie : Organ der Deutschen Rontgengesellschaft ... [et al] · 2023Trial
- Idiopathic Pneumonia Syndrome and Pulmonary Toxicity After Total Body Irradiation for Bone Marrow Transplantation in the Modern Transplant Era.Current oncology (Toronto, Ont.) · 2026Article
- Total body irradiation-based conditioning in allogeneic transplantation in patients with hematological malignancies: impact in outcomes by stem-cell source.Clinical & translational oncology : official publication of the Federation of Spanish Oncology Societies and of the National Cancer Institute of Mexico · 2026Article
- Incorporating Intensity Modulated Total Body Irradiation (IMRT-TBI) Into Future Cooperative Group Clinical Trials: An NRG Hematologic Malignancies Working Group-Led Report From the National Clinical Trials Network.International journal of radiation oncology, biology, physics · 2026Article
- Urgent and emergent radiotherapy for hematologic malignancies of the central nervous system: a review of the literature and practical approach.Frontiers in oncology · 2025Review
- The implementation of low instantaneous dose rate total body irradiation with linear accelerator in small-size treatment rooms.Journal of applied clinical medical physics · 2024Article
- Validation of Acuros for total body irradiation at extended distance.Journal of applied clinical medical physics · 2024Article
- Review
- Total body irradiation delivered using a dedicated Co-60 TBI unit: Evaluation of dosimetric uniformity and dose verification.Journal of applied clinical medical physics · 2024Article
- A phase 1 trial utilizing TMI with fludarabine-melphalan in patients with hematologic malignancies undergoing second allo-SCT.Blood advances · 2023Article
- The role of AMP-activated protein kinase in GVHD-causing T cells.Immunometabolism (Cobham, Surrey) · 2022Review
- Article
- Comparison of Pulmonary Toxicity after Total Body Irradiation- and Busulfan-Based Myeloablative Conditioning for Allogeneic Hematopoietic Stem Cell Transplantation in Pediatric Patients.Transplantation and cellular therapy · 2022Article
- Total marrow and lymphoid irradiation as conditioning in haploidentical transplant with posttransplant cyclophosphamide.Blood advances · 2022Article
- Optimized Conformal Total Body Irradiation methods with Helical TomoTherapy and Elekta VMAT: Implementation, Imaging, Planning and Dose Delivery for Pediatric Patients.Frontiers in oncology · 2022Article
- Volumetric modulated arc therapy based total marrow and lymphoid irradiation: Workflow and clinical experience.Frontiers in oncology · 2022Article
- Target Coverage and Normal Organ Sparing in Dose-Escalated Total Marrow and Lymphatic Irradiation: A Single-Institution Experience.Frontiers in oncology · 2022Article
- Treatment planning of total marrow irradiation with intensity-modulated spot-scanning proton therapy.Frontiers in oncology · 2022Article
- Total marrow irradiation (TMI): Addressing an unmet need in hematopoietic cell transplantation - a single institution experience review.Frontiers in oncology · 2022Review
- Long-term follow up of patients with hematological malignancies treated with total body irradiation using intensity modulated radiation therapy.Frontiers in oncology · 2022Article
Corrections and comments
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Authors and funding
17 authors at 9 institutions in 2 countries.
Funding
Abstract
purposeTo examine the relationship between lung radiation dose and survival outcomes in children undergoing total body irradiation (TBI)-based hematopoietic stem cell transplantation (HSCT) for acute lymphoblastic leukemia on the Children's Oncology Group trial. METHODS AND MATERIALS: TBI (1200 or 1320 cGy given twice daily in 6 or 8 fractions) was used as part of 3 HSCT preparative regimens, allowing institutional flexibility regarding TBI techniques, including lung shielding. Lung doses as reported by each participating institution were calculated for different patient setups, with and without shielding, with a variety of dose calculation techniques. The association between lung dose and transplant-related mortality, relapse-free survival, and overall survival (OS) was examined using the Cox proportional hazards regression model controlling for the following variables: TBI dose rate, TBI fields, patient position during TBI, donor type, and pre-HSCT minimal residual disease level.
resultsOf a total of 143 eligible patients, 127 had lung doses available for this analysis. The TBI techniques were heterogeneous. The mean lung dose was reported as 904.5 cGy (standard deviation, ±232.3). Patients treated with lateral fields were more likely to receive lung doses ≥800 cGy (P < .001). The influence of lung dose ≥800 cGy on transplant-related mortality was not significant (hazard ratio [HR], 1.78; P = .21). On univariate analysis, lung dose ≥800 cGy was associated with inferior relapse-free survival (HR, 1.76; P = .04) and OS (HR, 1.85; P = .03). In the multivariate analysis, OS maintained statistical significance (HR, 1.85; P = .04).
conclusionsThe variability in TBI techniques resulted in uncertainty with reported lung doses. Lateral fields were associated with higher lung dose, and thus they should be avoided. Patients treated with lung dose <800 cGy in this study had better outcomes. This approach is currently being investigated in the Children's Oncology Group AALL1331 study. Additionally, the Imaging and Radiation Oncology Core Group is evaluating effects of TBI techniques on lung doses using a phantom.
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