Hematologic Cancer

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MO_43_2750 - Pneumonitis Rates With and Without Lung Blocking Following a 12 Gy BID Low Dose-Rate Co-60 Total Body Irradiation Regimen

Monday, October 22
10:45 AM - 12:15 PM
Location: Innovation Hub, Exhibit Hall 3

Pneumonitis Rates With and Without Lung Blocking Following a 12 Gy BID Low Dose-Rate Co-60 Total Body Irradiation Regimen
R. Pearlman1, J. W. Burmeister2, A. Hammoud3, S. Patel1, A. Nalichowski3, and M. M. Dominello2; 1Detroit Medical Center, Wayne State University, Detroit, MI, 2Department of Oncology, Wayne State University School of Medicine, Detroit, MI, 3Karmanos Cancer Institute, Detroit, MI

Purpose/Objective(s): The purpose of this study was to determine and compare rates of pneumonitis due to total body irradiation (TBI) using a 12 Gy BID regimen with and without lung blocks. Studies have shown that pneumonitis is a dose dependent effect of irradiation of the lung. It was hypothesized that greater rates of pneumonitis would be observed in patients treated without lung blocks.

Materials/Methods: A retrospective, single institution analysis of 74 patients treated with TBI using a 12 Gy BID (Co-60) regimen with and without lung blocks from 2007-2016 was conducted. Fifty-one patients were treated without lung blocks (2007-2011), and 23 patients were treated with lung blocks (2012-2016). The dose rate range was approximately 2.2 cGy/min-7 cGy/min. Chemotherapy regimens that were used included cyclophosphamide and etoposide-based regimens. Pneumonitis was characterized by respiratory complications reported as pneumonitis occurring within a 6 month period following TBI. Grading of pneumonitis was performed based on the CTCAE version 4.03 criteria.

Results: In the cohort of patients without lung blocking, 6/51 (12%) patients developed grade 2 pneumonitis or greater, including 2 cases of grade 5 pneumonitis. In the cohort with lung blocking, 1/23 (4%) patients developed grade 2 pneumonitis without any instances of grade 3-5 pneumonitis.
Cohort Grade 2 Grade 3 Grade 4 Grade 5
Lung blocks (n=23) 1 (4%) 0 0 0
No lung blocks (n=51) 1 (2%) 3 (6%) 0 2 (4%)

Conclusion: In this study, we show that TBI using a 12 Gy BID regimen without lung blocks results in an elevated risk of clinically significant pneumonitis. Lung blocking is associated with a reduced occurrence of grade 2 or higher pneumonitis and currently remains the practice at our institution.

Author Disclosure: R. Pearlman: None. J.W. Burmeister: Research Grant; NIH. Board Member; SDAMPP. Chair, Radiation Oncology Physics Exam Committee; American Board of Radiology. A. Hammoud: None. S. Patel: None. A. Nalichowski: None.

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