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Sep 28
Education

EDU 08 - Radiotherapy for Leukemia: Past, Present and Future

04:45pm - 06:00pm PT
Hematologic Malignancies
Pediatric Cancer

MODERATOR(S)

Sarah Milgrom, MD - University of Colorado School of Medicine

Colton Ladbury, MD, BS - City of Hope National Medical Center

session DESCRIPTION

The use of radiotherapy (RT) in the management of leukemia has evolved. Historically, RT was critical for disease control in sanctuary sites, such as the central nervous system (CNS) and testes. However, modern chemotherapy is highly effective, even within sanctuary sites, so RT utilization has declined substantially. Nonetheless, RT maintains some important roles. For example, in young patients with acute lymphoblastic leukemia undergoing stem cell transplantation (SCT), a total body irradiation (TBI)-based preparative regimen has been associated with improved survival, when compared to myeloablative chemotherapy regimens. Historically, TBI was delivered using static, parallel opposed photon beams (2D-TBI); however, recently, centers have increasingly used intensity modulated radiation therapy (IMRT) techniques. Relative to 2D-TBI, IMRT can reduce doses to critical organs while delivering myeloablative doses to the rest of the body, so it may decrease the risk of toxicity while maintaining oncologic outcomes. Multi-organ-sparing, dose-escalated total marrow irradiation (TMI) and total marrow/lymphoid irradiation (TMLI) are related concepts that aim to reduce toxicity and increase efficacy in patients without standard SCT options, including those with persistent, chemorefractory disease. IMRT-based TBI, as well as TMI/TMLI, may continue to expand and redefine how RT is used as a part of leukemia therapy.

learning objectives

  1. Explain how and why indications for radiotherapy in leukemias have changed with time.
  2. Describe the potential advantages, as well as the challenges, of delivering total body irradiation using conformal techniques.
  3. Discuss potential future applications of radiotherapy in the management of leukemia, including total marrow irradiation and total marrow/lymphoid irradiation.

Credits

AMA PRA Category 1 Credits: 1.25

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