ORIGINAL RESEARCH article
Front. Oncol.
Sec. Hematologic Malignancies
Multi-Isocentric Volumetric Arc-Based Total Body Irradiation: Radiation Dose Impact on Oncological Outcomes in Patients Receiving Allogeneic Hematopoietic Cell Transplantation
Provisionally accepted
- 1Department of Oncology and Radiotherapy,, University Clinical Centre in Gdańsk, Gdańsk, Poland
- 2Department of Oncology and Radiotherapy, Medical university of Gdansk, Gdansk, Poland
- 3Department of Hematology and Transplantology, Medical university of Gdansk, Gdansk, Poland
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Background and purpose: Total body irradiation (TBI) is an important component of conditioning schedules. Data comparing different radiotherapy (RT) regimens in allogeneic hematopoietic cell transplantation (allo-HCT) remain limited. We aimed to evaluate the oncological outcomes of patients receiving different RT doses. Materials and methods: All patients treated with multi-isocentric volumetric arc-based total body irradiation (VMAT-TBI) at a dose of ≥>8 Grays (Gy) between 2021 and 2023 were included in this retrospective analysis. The RT regimens were either 8 Gy delivered in 4 bi-daily fractions (fx) or 12 Gy in 6 bi-daily fx. We evaluated the overall survival (OS), relapse-free survival (RFS), engraftment, and toxicities in both groups. Results: Forty-two patients met the inclusion criteria, including 24 treated with a 12 Gy regimen. Hazard ratio for OS after adjusting for age, Charlson Comorbidity Index (CCI), Disease Risk Index (DRI), disease status and total conditioning score (TCI) for survival was 0.02 (0.00, 0.48. p=0.01) in favor of a higher dose. The median RFS in the 12 Gy cohort was not achieved, and it was 11.8 months in the 8 Gy group. Toxicities were comparable between the groups. Two treatment-related deaths occurred in the 8 Gy arm. All patients in the 12 Gy arm achieved engraftment, whereas one graft failure was observed in the 8 Gy arm. Conclusion: In patients receiving modern TBI before allo-HCT with high-quality dose distribution, 12 Gy appears to be more effective than 8 Gy. However, this concerns a single-center cohort with TBI dose allocation according to estimated patient fragility before transplant. Therefore, randomized trials are required to determine the optimal RT dose.
Keywords: bone marrowtransplantation, conditioning, Radiotherapy dose, total body irradiation dose, volumetric modulated arc therapy
Received: 29 Aug 2025; Accepted: 15 Dec 2025.
Copyright: © 2025 Romanowska, Kamińska, Sadowska-Klasa, Prawdzik–Dampc and Zaucha. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Anna Romanowska
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