Total marrow irradiation versus total body irradiation using intensity-modulated helical tomotherapy

J Cancer Res Clin Oncol. 2023 Aug;149(9):5965-5973. doi: 10.1007/s00432-022-04565-2. Epub 2023 Jan 6.


Background: Total body irradiation (TBI) is often a component of the conditioning regimen prior to hematopoietic stem cell transplantation in patients with hematological malignancies. However, total marrow irradiation (TMI) could be an alternative method for reducing radiation therapy-associated toxicity, as it specifically targets the skeleton and thus could better protect organs at risk. Here, we compared dosimetric changes in irradiation received by the target volume and organs at risk between TBI and TMI plans.

Materials and methods: Theoretical TMI plans were calculated for 35 patients with various hematological malignancies who had already received TBI in our clinic. We then statistically compared irradiation doses between the new TMI plans and existing TBI plans. We examined whether TMI provides greater protection of organs at risk while maintaining the prescribed dose in the targeted skeletal area. We also compared beam-on times between TBI and TMI.

Results: TMI planning achieved significant reductions in the mean, minimum, and maximum irradiation doses in the lungs, kidneys, liver, spleen, and body (i.e., remaining tissue except organs and skeleton). In particular, the mean dose was reduced by 49% in the liver and spleen and by 55-59% in the kidneys. Moreover, TMI planning reduced the corpus beam-on time by an average of 217 s.

Conclusion: TMI planning achieved significant dose reduction in organs at risk while still achieving the prescribed dose in the target volume. Additionally, TMI planning reduced the beam-on time for corpus plans despite a high modulation factor.

Keywords: Hematological malignancy; Hematopoietic stem cell transplantation; Radiotherapy; Total body irradiation; Total marrow irradiation; Treatment planning.

MeSH terms

  • Bone Marrow
  • Carmustine
  • Etoposide
  • Hematologic Neoplasms*
  • Humans
  • Radiation Injuries*
  • Radiotherapy Dosage
  • Radiotherapy Planning, Computer-Assisted / methods
  • Radiotherapy, Intensity-Modulated* / methods
  • Whole-Body Irradiation / methods


  • Carmustine
  • Etoposide