Gonadal-sparing total body irradiation with the use of helical tomotherapy for nonmalignant indications

Abstract

background: the aim was to demonstrate the feasibility and technique of gonadal sparing total body irradiation (tBi) with helical tomotherapy. total body irradiation is a common part of the conditioning regimen prior to allogeneic stem cell transplantation. Shielding or dose-reduction to the gonads is often desired to preserve fertility, particularly in young patients undergoing transplant for non-malignant indications. helical tomotherapy (ht) has been shown to be superior to traditional tBi delivery for organ at risk (oaR) doses and dose homogeneity. Materials and methods: We present two representative cases (one male and one female) to illustrate the feasibility of this technique, each of whom received 3Gy in a single fraction prior to allogeneic stem cell transplant for benign indications. the planning target volume (PtV) included the whole body with a subtraction of oaRs including the lungs, heart, and brain (each contracted by 1cm) as well as the gonads (testicles expanded by 5 cm and ovaries expanded by 0.5 cm). results: For the male patient we achieved a homogeneity index of 1.35 with a maximum and median planned dose to the testes of 0.53 Gy and 0.35 Gy, respectively. in-vivo dosimetry demonstrated an actual received dose of 0.48 Gy. For the female patient we achieved a homogeneity index of 1.13 with a maximum and median planned dose to the ovaries of 1.66 Gy and 0.86 Gy, respectively. conclusion: Gonadal sparing tBi is feasible and deliverable using ht in patients with non-malignant diseases requiring tBi as part of a pre-stem cell transplant conditioning regimen.