Total body Radiation therapy for Patients with Blood Cancers

Many wonder whether radiation can be delivered to the whole body. This question is often asked by stage IV (disseminated) cancer patients. Yes, there is a possibility for giving radiation to the entire body it is reserved for limited indications but not for disseminated cancer. Total-body irradiation (TBI) is a key part of the conditioning regimen before hematopoietic stem cell transplantation (HSCT). It is utilised in multiple medical conditions like chronic lymphocytic leukemia (CLL), low-grade non-Hodgkin’s lymphoma (l-NHL), acute lymphocytic leukemia, acute myeloid leukemia (AML) and chronic myeloid leukemia (CML), Sickle cell disease, MDS etc.

TBI is technically demanding and one of the most complex radiation treatments as it involves treatment of the entire body. The process involves creation of a dedicated immobilization device which ensures patient comfort. The majority of patients receiving TBI are of the paediatric age group so we need to ensure that they do not move during treatment. The state-of-the-art techniques like Volumetric Modulated arc therapy (VMAT)help to achieve precise Dosemetric distribution to the complex large areas.

Another prerequisite of TBI is the maintenance of aseptic environment for treatment. The LINAC  premises are diligently cleaned prior to each session of radiation therapy because the patients receiving TBI are immunocompromised. A military discipline in the team is required for execution of this treatment. Despite being demanding and time consuming. It is a very rewarding treatment in terms of outcomes and forms a key component of the bone marrow transplant program.

Such techniques should only be performed at centres with experience and a dedicated set up and comprehensive care under one roof.

Author : Dr. Kanika Sharma, Director & Clinical Lead – Radiation Oncology, Dharamshila Narayana Superspeciality Hospital, Delhi