Total Body Irradiation in Hematopoietic Stem Cell Transplantation
Summary
Total Body Irradiation (TBI) is a cornerstone of conditioning regimens for haematopoietic stem cell transplantation. By delivering a relatively uniform dose of ionising radiation to the entire body, TBI serves both cytotoxic and immunosuppressive roles: it eradicates residual malignant cells and ablates the host immune system to prevent graft rejection. Traditional techniques employ extended‐distance parallel‐opposed beams, often with manual lung shielding to reduce pulmonary toxicity. Over the past decade, advanced delivery methods—such as volumetric modulated arc therapy, intensity-modulated approaches and helical tomotherapy—have enabled more homogeneous dose distributions and selective sparing of organs at risk. Integration of image guidance, multi-isocentre planning and dose-recalculation on treatment-day imaging has enhanced accuracy and workflow efficiency. Current practice seeks an optimal balance between maximising tumour control, preserving sanctuary‐site penetration and minimising acute and late toxicities in both paediatric and adult populations.
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Total Body Irradiation in Hematopoietic Stem Cell Transplantation publication trend
The graph below shows the total number of articles in total body irradiation in hematopoietic stem cell transplantation across all publications each year (not limited to Nature Index journals).
Technical terms
Total Body Irradiation (TBI): Uniform delivery of radiation to the entire body as part of transplant conditioning.
Hematopoietic Stem Cell Transplantation: Infusion of bone marrow or peripheral blood progenitor cells to reconstitute haematopoiesis after conditioning.
Myeloablative Conditioning: High‐dose chemotherapy and/or radiation regimen that eradicates bone marrow function to enable donor engraftment.
Volumetric Modulated Arc Therapy (VMAT): Rotational radiation technique using dynamic fields and multileaf collimators for conformal dose shaping.
Planning Target Volume (PTV): Anatomical region defined to include the clinical target plus margins for organ motion and setup uncertainty.
Organs at Risk (OAR): Normal tissues susceptible to radiation damage that require dose limitation during treatment planning.
Dose Rate: Speed at which radiation dose is delivered, typically expressed in centigray per minute and influencing toxicity profiles.
References
- Total marrow lymphoid irradiation IMRT treatment using a novel CT-linac. European Journal of Medical Research (2023).
- Total body irradiation with volumetric modulated arc therapy: Dosimetric data and first clinical experience. Radiation Oncology (2016).
- Intensity-modulated Total Body Irradiation (TBI) with TomoDirect™. Radiation Oncology (2015).
- Total Body Irradiation (TBI) using Helical Tomotherapy in children and young adults undergoing stem cell transplantation. Radiation Oncology (2013).
- CT‐based analysis of dose homogeneity in total body irradiation using lateral beam. Journal of Applied Clinical Medical Physics (2004).
- Extended SSD VMAT treatment for total body irradiation. Journal of Applied Clinical Medical Physics (2018).
- Current practice in total-body irradiation: results of a Canada-wide survey.. Current Oncology (2017).
- Pulmonary Toxicity After Total Body Irradiation – Critical Review of the Literature and Recommendations for Toxicity Reporting. Frontiers in Oncology (2021).
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