PMID- 11163505
OWN - NLM
STAT- MEDLINE
DCOM- 20010329
LR  - 20190708
IS  - 0360-3016 (Print)
IS  - 0360-3016 (Linking)
VI  - 49
IP  - 1
DP  - 2001 Jan 1
TI  - Long-term complications of total body irradiation in adults.
PG  - 125-31
AB  - PURPOSE: To report long-term pulmonary, thyroid, and ocular complications in 
      patients who had conditioning regimens including total body irradiation (TBI) 
      before bone marrow transplantation (BMT). METHODS AND MATERIALS: Between June 
      1986 and December 1995, 478 patients received TBI in our institution. The present 
      study includes 186 adult patients who had complete remission lasting one year or 
      more after BMT. There were 108 males and 78 females. Median age was 36.5 years 
      (range 15-60). Initial diagnoses were lymphomas (50%), acute lymphoid leukemias 
      (16%), acute myeloid leukemias (16%), chronic myeloid leukemia (13%), aplastic 
      anemia (3%), and myelodysplasia (2%). At the time of BMT, 43.5% of patients were 
      in complete response and 56.5% in partial response. Treatment consisted of a 
      single dose TBI at 10 Gy in 9% and fractionated TBI delivering 12 to 13.5 Gy in 6 
      fractions in 91%. From 1986 to October 1991, TBI was performed in lateral 
      position with 9 MV energy (57% of patients) and thereafter in alternate prone and 
      supine positions with 15 MV energy (43%). Chemical conditioning regimen was 
      cyclophosphamide (60 mg/kg at D-4 and D-3) in 69% and CBV (cyclophosphamide 1500 
      mg/m(2) from D-6 to D-3, BCNU 300 mg/m(2) at D-6, VP-16 200 mg/m(2) from D-6 to 
      D-4) in 25%. Fifty eight percent of patients received autologous and 42% 
      allogeneic BMT. All patients had clinical, biologic, and functional examinations 
      at one-year intervals. RESULTS: Median follow-up from BMT was 49 months (range 
      12-136). Late pulmonary effects were observed only in functional explorations, 
      without clinical effect, including restrictive syndrome in 8% and alteration in 
      the diffusing capacity of carbon monoxide in 12%. No patient showed clinical 
      thyroid symptoms, and 10% developed biologic dysfunction: hypothyroidism (6.5%), 
      thyroiditis (3%), and Basedow disease (0.5%). Ocular complications occurred in 
      29.5%, including cataract (15%), dry syndrome (13%), and keratitis (1.5%). In 
      univariate and multivariate analysis, pulmonary complications were statistically 
      increased by chronicle graft vs. host disease (GVHD) vs. no (p = 0.02), prone and 
      supine vs. lateral TBI position (p = 0.02), and with 15 MV vs. 9 MV beam energy 
      (p = 0.02). Cataract occurred less frequently with fractionated than with 
      single-dose TBI (p = 0.000002). No differences were observed regarding age, sex, 
      initial diagnosis, status at the time of BMT, conditioning chemotherapy regimen, 
      and total dose of TBI. CONCLUSION: From this retrospective study it was shown 
      that long-term complications of TBI were not symptomatic in most patients. The 
      role of parameters of irradiation and especially position of treatment and beam 
      energy should be emphasized and assessed with a longer follow-up.
FAU - Thomas, O
AU  - Thomas O
AD  - Department of Radiotherapy, Centre Rene Gauducheau, Saint-Herblain, Nantes, 
      France. olivier.thomas1@libertysurf.fr
FAU - Mahe, M
AU  - Mahe M
FAU - Campion, L
AU  - Campion L
FAU - Bourdin, S
AU  - Bourdin S
FAU - Milpied, N
AU  - Milpied N
FAU - Brunet, G
AU  - Brunet G
FAU - Lisbona, A
AU  - Lisbona A
FAU - Le Mevel, A
AU  - Le Mevel A
FAU - Moreau, P
AU  - Moreau P
FAU - Harousseau, J
AU  - Harousseau J
FAU - Cuilliere, J
AU  - Cuilliere J
LA  - eng
PT  - Journal Article
PL  - United States
TA  - Int J Radiat Oncol Biol Phys
JT  - International journal of radiation oncology, biology, physics
JID - 7603616
SB  - IM
MH  - Adolescent
MH  - Adult
MH  - Analysis of Variance
MH  - *Bone Marrow Transplantation
MH  - Eye Diseases/*etiology
MH  - Female
MH  - Follow-Up Studies
MH  - Humans
MH  - Leukemia/drug therapy/therapy
MH  - Lung Diseases/*etiology
MH  - Lymphoma/drug therapy/therapy
MH  - Male
MH  - Middle Aged
MH  - Radiation Injuries/*etiology
MH  - Retrospective Studies
MH  - Thyroid Diseases/*etiology
MH  - Transplantation Conditioning/*adverse effects
MH  - Whole-Body Irradiation/*adverse effects
EDAT- 2001/02/13 11:00
MHDA- 2001/04/03 10:01
CRDT- 2001/02/13 11:00
PHST- 2001/02/13 11:00 [pubmed]
PHST- 2001/04/03 10:01 [medline]
PHST- 2001/02/13 11:00 [entrez]
AID - S0360301600013730 [pii]
AID - 10.1016/s0360-3016(00)01373-0 [doi]
PST - ppublish
SO  - Int J Radiat Oncol Biol Phys. 2001 Jan 1;49(1):125-31. doi: 
      10.1016/s0360-3016(00)01373-0.