Volumetric Modulated Arc Therapy Total Body Irradiation (VMAT-TBI) in Pediatric and Adolescent/Young Adult Patients Undergoing Stem Cell Transplantation: Early Outcomes and Toxicities

Abstract

<h3>Purpose/Objective(s)</h3> Total body irradiation (TBI) is an important component of many conditioning regimens for hematopoietic stem cell transplantation (HSCT), most commonly used in pediatric and adolescent/young adult (AYA) patients. We aimed to evaluate outcomes and toxicities among pediatric and AYA patients treated with TBI utilizing volumetric modulated arc therapy (VMAT-TBI). <h3>Materials/Methods</h3> We reviewed pediatric and AYA patients treated with VMAT-TBI at our institution from 2019-2021. Data on patient and disease characteristics, treatment details, outcomes and toxicities were collected. Overall survival (OS) and relapse free survival (RFS) were analyzed using the Kaplan-Meier method. <h3>Results</h3> Among 38 patients, 16 (42.1%) were treated with myeloablative regimens and 22 (57.9%) with non-myeloablative regimens. Median age was 7.2 years (range: 1-27) and median follow-up was 8.7 months (range: 1-21). Lungs D_mean was 7.3±0.3 Gy for myeloablative regimens (range: 6.8–7.8). Kidneys were spared to average mean dose of 71.4±4.8% of prescription dose. Gonadal sparing was achieved for patients treated for non-malignant diseases to D_mean of 0.7±0.1 Gy. No patient experienced primary graft failure; one (2.6%) experienced secondary graft failure. The most common grade 1-2 acute toxicities were nausea (68.4%) and fatigue (55.3%). Mucositis was the most common grade 3-4 acute toxicity, affecting 39.5% of patients. There were no cases of pneumonitis or nephrotoxicity attributable to TBI. <h3>Conclusion</h3> VMAT-TBI offers increased ability to spare organs at risk in pediatric and AYA patients undergoing HSCT, with a favorable acute/subacute toxicity profile and excellent disease control.