Received 23-02-2006; Accepted 07-04-2006 Author and address for correspondence: Rodica Anghel, MD, PhD Institute of Oncology Bucharest 252 Fundeni Street, Sector 2 PO 022328 Bucharest Romania E-mail: ranghel@iob.ro Journal of BUON 11: 167-174, 2006 © 2006 Zerbinis Medical Publications. Printed in Greece ORIGINAL ARTICLE T otal body irradiation prior to bone marrow transplantation - the experience of the Institute of Oncology “Prof. Dr. Al. Trestioreanu” Bucharest R. Anghel 1,2 , G. Matache 2 , M. Vasile 2 , R.I. Matache 1 , L. Oprea 2 , R. Popa 2 , A. Sucitu 2 , N. Costandache 2 , I. Bărbulescu 2 , D. Colita 3 , Z. Varady 3 , A. Tanase 3 , A. Moicean 3 , C. Arion 4 , A. Colita 4 , L. Dumitrache 4 1 University of Medicine and Pharmacy “Carol Davila”, Bucharest; 2 Institute of Oncology “Prof. Dr. Al. Trestioreanu”, Department 2 of Radiotherapy, Bucharest; 3 Fundeni Clinical Institute, Department of Hematology and Bone Marrow Transplantation, Bucharest; 4 Fundeni Clinical Institute, Department of Pediatrics and Department of Bone Marrow Transplantation Department, Bucharest, 4 Romania Summary Purpose: T o present the technique of total body ir- radiation (TBI), applied for the first time in Romania, at the Institute of Oncology Bucharest, as part of stem cell transplantation for hematological malignancies. Patients and methods: The total dose administered was 12 Gy at the reference point, 2 Gy/fraction, one fraction per day , 6 consecutive days, with a total dose of 8 - 11.4 Gy delivered to the lung, using Mevatron Primus linear ac- celerator (6 MV & 15 MV, 200-300 cGy/min in isocenter), in vivo dosimetry detectors and equipment for the reference dosimetry, personalized blocks for lung shielding sustained by polymethylmethaacrylate (PPMA) plate, Simulix HP simulator, and computer tomographic (CT) scans. Tech- niques used were: a) two parallel opposed anteroposterior / posteroanterior (AP/PA) fields with the patient in prone and supine position; b) two parallel opposed lateral fields with the patient placed on a lateral table, at 320 cm from the source. The percentage depth dose, tissue maximum ratio (TMR), off axis ratio (OAR) and the reference dose rate were measured for every patient’s geometrical characteristics, with an uncertainty of ± 2.2% and were used to calculate monitor units and to evaluate the dose in organs at risk (lungs, gonads, eyes etc). Results: 5 patients (3 with the AP/PA technique and 2 with the lateral technique) were irradiated. All patients completed their irradiation in good clinical condition. The acute side effects were minimal (WHO grade 1: nausea/ vomiting – all patients; diarrhea – 1 patient; headache – 2 patients; photophobia and diplopia – 1 patient; head and neck skin erythema – all patients). Because of the short fol- low-up period no safe evaluation of late side effects can be done. However, during this period one patient developed a non-aggressive form of chronic liver graft vs. host disease (GVHD) and one patient died due to acute GVHD. Conclusion: TBI as part of stem cell transplantation for hematological malignancies was successfully realized at our Institute, with favorable clinical results. This technique is easy to carry out and reproducible. Key words: hematological malignancies, in vivo dosim- etry , radiotherapy , stem cell transplantation, total body irradiation Introduction Stem cell transplantation is a systemic therapy for hematological malignancies with rapid expansion during the last 30 years (more than 23,000 transplan- tations in 2001 all over the world), with remarkable results [1]. Nowadays the main indications for stem cell transplantation are acute lymphoblastic leukemia (ALL), acute myeloid leukemia (AML), chronic my- elogenous leukemia (CML), multiple myeloma, some malignant lymphomas, and some solid tumors.