nodgoРоссийский журнал детской гематологии и онкологии (РЖДГиО)Russian Journal of Pediatric Hematology and Oncology2311-12672413-5496LTD “Graphica”10.17650/2311-1267-2016-3-2-64-67nodgo-216Research ArticleОРИГИНАЛЬНЫЕ ИССЛЕДОВАНИЯ/ОБЗОРЫ ЛИТЕРАТУРЫORIGINAL INVESTIGATIONS/LITERATURE REVIEWSПервый российский опыт применения томотерапии для проведения тотального облучения тела у детейThe first Russian experience of TomoTherapy for total body irradiation in childrenКобызеваД. А.KobyzevaD. A.

117997, Москва, ул. Саморы Машела, 1

1 Samory Mashela St., Moscow, 117997

daria.kobyzeva@gmail.comМасчанМ. А.MaschanM. A.

117997, Москва, ул. Саморы Машела, 1

1 Samory Mashela St., Moscow, 117997

ВиллихН. А.WillichN. A.

117997, Москва, ул. Саморы Машела, 1

1 Samory Mashela St., Moscow, 117997

ЛогиноваА. А.LoginovaA. A.

117997, Москва, ул. Саморы Машела, 1

1 Samory Mashela St., Moscow, 117997

НечеснюкА. В.NechesnyukA. V.

117997, Москва, ул. Саморы Машела, 1

1 Samory Mashela St., Moscow, 117997

ФГБУ «ФНКЦ ДГОИ им. Дмитрия Рогачева» Минздрава РоссииРоссияFederal Research Center of Pediatric Hematology, Oncology and Immunology named after Dmitriy Rogachev, Ministry of Health of RussiaRussian Federation201601062016326467Copyright © Кобызева Д.А., Масчан М.А., Виллих Н.А., Логинова А.А., Нечеснюк А.В., 20162016Кобызева Д.А., Масчан М.А., Виллих Н.А., Логинова А.А., Нечеснюк А.В.Kobyzeva D.A., Maschan M.A., Willich N.A., Loginova A.A., Nechesnyuk A.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://journal.nodgo.org/jour/article/view/216Введение

Введение. Комбинация тотального облучения тела (ТОТ) с химиотерапией широко используется во всем мире в качестве режима кондиционирования перед трансплантацией гемопоэтических стволовых клеток у больных гемобластозами. Она продемонстрировала лучшие результаты выживаемости пациентов в сравнении с режимами кондиционирования, включающими только химиотерапию.

Цель – разработка методики ТОТ у детей на аппарате TomoTherapy и включение его в протокол кондиционирования перед проведением аллогенной трансплантации костного мозга.

Материалы и методы

Материалы и методы. В период с июля 2014 по февраль 2016 г. лучевая терапия проведена 38 пациентам. Лечение проводилось ежедневно, 2 раза в день с разовой очаговой дозой на протяженную мишень PTV (Planed Target Volume – планируемый объем облучения) 2,0 Гр до суммарной очаговой дозы 12,0 Гр. Учитывая потенциальную чувствительность здоровых органов и основываясь на литературных данных, были выбраны следующие органы риска: легкие, почки и передняя камера глаза.

Результаты

Результаты. Все больные закончили планируемую программу лечения. Период наблюдения составил от 0 до 21 мес (средний период – 7,2 мес). За это время развития явлений поздней лучевой токсичности со стороны критических органов (легкие, почки, хрусталики) не наблюдалось ни у одного из пациентов.

Выводы

Выводы. Проведение ТОТ на аппарате TomoTherapy дает возможность обеспечить максимальный контроль над распределением дозы облучения в PTV с одновременным снижением дозы на критические органы. Это позволяет добиться уменьшения вероятности развития серьезных последствий лучевой терапии и высокой эффективности лечения.

Background

Background. Combination of total body irradiation (TBI) with chemotherapy is widely used technique for conditioning before hematopoietic stem cell transplantation for patient with hematological malignancies worldwide. Best results of patient’s survival were showed in comparison with conditioning regimen included only chemotherapy.

Aim – development of TBI technique at children with the help of TomoTherapy equipment and including it to the conditioning protocol before allogenic bone marrow transplantation.

Materials and methods

Materials and methods. During the period between July 2014 and February 2016 radiation therapy was made for 38 patients. Treatment was performed daily, 2 times per day with single basic dose on extended target (PTV) 2 Gr to total focal dose 12 Gr. Taking into account potential sensitivity of healthy organs and based on literature data, the following risk organs were chosen: lungs, kidneys and anterior eye chamber.

Results

Results. All patients successfully passed the planned program of treatment. Follow-up period was from 0 to 21 months (average – 7.2 months). No one of the patients did not showed any toxic episodes from the critical organs (lungs, kidneys, eye lens).

Conclusions

Conclusions. TBI on TomoTherapy equipment allows to provide maximal control on irradiation dose distribution in PTV with the decreasing of radiation for critical organs. This allows achieving the decreasing of possibility of serious complications of radiation therapy and high effectiveness of treatment.

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The authors declare that there are no conflicts of interest present.