Immediate toxicity during fractionated total body irradiation as conditioning for bone marrow transplantation

Radiother Oncol. 2000 Feb;54(2):157-62. doi: 10.1016/s0167-8140(99)00178-4.


Background: Total body irradiation followed by bone marrow transplantation is well established as a part of the conditioning regimen in high dose therapy. The immediate tolerance of fractionated total body irradiation (FTBI) was investigated prospectively.

Methods: From January 1995 to December 1998 162 patients received a FTBI, 6x2 Gy on 3 consecutive days, lung dose 10 Gy, for allogeneic (n=112) or autologous (n=50) bone marrow transplantation. High dose chemotherapy (mostly Cyclophosphamide) was administered after the FTBI. A standardized supportive therapy was administered. The immediate toxicity of FTBI was evaluated prospectively prior to each radiation fraction using a defined questionnaire.

Results: Main symptoms distressing the patient during irradiation period were gastrointestinal symptoms like nausea and emesis. The prevalence of nausea per fraction increased to 26.1% after the 4th fraction, with a significant higher prevalence in children younger than 10 years at 1st and 2nd fractions. 42.6 and 22. 8%, respectively, of all patients complained of nausea and episodes of emesis, during FTBI. Mild xerostomia and parotiditis were observed in 29.9 and 7.1% of all patients. Further gastrointestinal side effects during FTBI were loss of appetite in 16.0%, indisposition in 25.3%, mild oesophagitis in 3.7% and diarrhoea in 3. 7% of the patients. During FTBI 41.4% of the patients developed a temporary skin irritation (mild erythema). Pruritus was registered in 3.7% of the patients. Headache was observed in 14.8% and Fatigue syndrome in 49.2% of women and 28.3% of men (P<0.005).

Conclusion: FTBI is a well tolerated therapeutic regimen in high dose therapy. The 162 patients investigated revealed no severe immediate side effects.

Publication types

  • Comparative Study

MeSH terms

  • Adolescent
  • Adult
  • Bone Marrow / radiation effects*
  • Bone Marrow Transplantation / immunology
  • Bone Marrow Transplantation / methods*
  • Child
  • Child, Preschool
  • Dose Fractionation, Radiation*
  • Dose-Response Relationship, Radiation
  • Female
  • Humans
  • Leukemia / immunology
  • Leukemia / therapy*
  • Lymphoma / immunology
  • Lymphoma / therapy*
  • Male
  • Middle Aged
  • Prevalence
  • Prospective Studies
  • Radiation Injuries / epidemiology
  • Radiation Injuries / etiology*
  • Radiation Injuries / prevention & control
  • Surveys and Questionnaires
  • Transplantation Conditioning / methods*
  • Treatment Outcome
  • Whole-Body Irradiation*