{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,9]],"date-time":"2026-01-09T07:16:21Z","timestamp":1767942981494,"version":"3.49.0"},"reference-count":35,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,1,9]],"date-time":"2026-01-09T00:00:00Z","timestamp":1767916800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Oncol."],"abstract":"<jats:sec>\n                    <jats:title>Background and purpose<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and methods<\/jats:title>\n                    <jats:p>All patients treated with multi-isocentric volumetric arc-based total body irradiation (VMAT-TBI) at a dose of \u22658 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fonc.2025.1695178","type":"journal-article","created":{"date-parts":[[2026,1,9]],"date-time":"2026-01-09T05:14:54Z","timestamp":1767935694000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Multi-isocentric volumetric arc-based total body irradiation: radiation dose impact on oncological outcomes in patients receiving allogeneic hematopoietic cell transplantation"],"prefix":"10.3389","volume":"15","author":[{"given":"Anna","family":"Romanowska","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joanna","family":"Kami\u0144ska","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alicja","family":"Sadowska-Klasa","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anita","family":"Prawdzik\u2013Dampc","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Renata","family":"Zaucha","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,1,9]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1016\/j.critrevonc.2018.01.011","article-title":"Total body irradiation in allogeneic bone marrow transplantation conditioning regimens: A review","volume":"123","author":"Paix","year":"2018","journal-title":"Crit Rev Oncol Hematol"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.3346\/jkms.2021.36.e55","article-title":"Current use of total body irradiation in haploidentical allogeneic hematopoietic stem cell transplantation","volume":"36","author":"Jung","year":"2021","journal-title":"J Kor Med Sci"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1038\/bmt.2015.6","article-title":"Indications for allo- and auto-SCT for haematological diseases, solid tumours and immune disorders: current practice in Europe, 2015","volume":"50","author":"Sureda","year":"2015","journal-title":"Bone Marrow Transplant"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.1016\/S1470-2045(12)70349-2","article-title":"Reduced-intensity conditioning versus standard conditioning before allogeneic haemopoietic cell transplantation in patients with acute myeloid leukaemia in first complete remission: a prospective, open-label randomised phase 3 trial","volume":"13","author":"Bornh\u00e4user","year":"2012","journal-title":"Lancet Oncol"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1182\/blood.V76.9.1867.1867","article-title":"Allogeneic marrow transplantation in patients with acute myeloid leukemia in first remission: a randomized trial of two irradiation regimens","volume":"76","author":"Clift","year":"1990","journal-title":"Blood"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2005-04-1377","article-title":"Conditioning with 8-Gy total body irradiation and fludarabine for allogeneic hematopoietic stem cell transplantation in acute myeloid leukemia","volume":"106","author":"Stelljes","year":"2005","journal-title":"Blood"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2010-01-264077","article-title":"The outcome of full-intensity and reduced-intensity conditioning matched sibling or unrelated donor transplantation in adults with Philadelphia chromosome\u2013negative acute lymphoblastic leukemia in first and second complete remission","volume":"116","author":"Marks","year":"2010","journal-title":"Blood"},{"key":"B8","doi-asserted-by":"publisher","first-page":"e812","DOI":"10.1097\/HS9.0000000000000812","article-title":"Reduced 8-gray compared to standard 12-gray total body irradiation for allogeneic transplantation in first remission acute lymphoblastic leukemia: A study of the acute leukemia working party of the EBMT","volume":"7","author":"Spyridonidis","year":"2023","journal-title":"Hemasphere"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.1016\/0021-9681(87)90171-8","article-title":"A new method of classifying prognostic comorbidity in longitudinal studies: Development and validation","volume":"40","author":"Charlson","year":"1987","journal-title":"J Chron Dis"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2012-03-418202","article-title":"A disease risk index for patients undergoing allogeneic stem cell transplantation","volume":"120","author":"Armand","year":"2012","journal-title":"Blood"},{"key":"B11","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2014-01-552984","article-title":"Validation and refinement of the Disease Risk Index for allogeneic stem cell transplantation","volume":"123","author":"Armand","year":"2014","journal-title":"Blood"},{"key":"B12","doi-asserted-by":"publisher","DOI":"10.1038\/s41409-020-0803-y","article-title":"Redefining and measuring transplant conditioning intensity in current era: a study in acute myeloid leukemia patients","volume":"55","author":"Spyridonidis","year":"2020","journal-title":"Bone Marrow Transplant"},{"key":"B13","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2018.04.071","article-title":"Total body irradiation: guidelines from the international lymphoma radiation oncology group (ILROG)","volume":"101","author":"Wong","year":"2018","journal-title":"Int J Radiat Oncol Biol Phys"},{"key":"B14","doi-asserted-by":"publisher","DOI":"10.1016\/j.clml.2023.01.004","article-title":"Total body irradiation versus chemotherapy conditioning in pediatric acute lymphoblastic leukemia patients undergoing hematopoietic stem cell transplant: A systematic review and meta-analysis","volume":"23","author":"Rehman","year":"2023","journal-title":"Clin Lymphoma Myeloma Leuk"},{"key":"B15","doi-asserted-by":"publisher","first-page":"17","DOI":"10.5144\/1658-3876.2011.17","article-title":"Cyclophosphamide plus total body irradiation compared with busulfan plus cyclophosphamide as a conditioning regimen prior to hematopoietic stem cell transplantation in patients with leukemia: a systematic review and meta-analysis","volume":"4","author":"Gupta","year":"2011","journal-title":"Hematol Oncol Stem Cell Ther"},{"key":"B16","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.28768","article-title":"Extreme heterogeneity of myeloablative total body irradiation techniques in clinical practice: A survey of the Acute Leukemia Working Party of the European Group for Blood and Marrow Transplantation","volume":"120","author":"Giebel","year":"2014","journal-title":"Cancer"},{"key":"B17","doi-asserted-by":"publisher","DOI":"10.1016\/j.radonc.2020.10.032","article-title":"Towards homogenization of total body irradiation practices in pediatric patients across SIOPE affiliated centers. A survey by the SIOPE radiation oncology working group","volume":"155","author":"Hoeben","year":"2021","journal-title":"Radiother Oncol"},{"key":"B18","doi-asserted-by":"publisher","DOI":"10.1016\/0360-3016(89)90105-3","article-title":"Total body irradiation in acute myeloid leukemia and chronic myelogenous leukemia: influence of dose and dose-rate on leukemia relapse","volume":"17","author":"Scarpati","year":"1989","journal-title":"Int J Radiat Oncol Biol Phys"},{"key":"B19","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2141.1989.tb00254.x","article-title":"The effect of total body irradiation dose and chronic graft-versus-host disease on leukaemic relapse after allogeneic bone marrow transplantation","volume":"73","author":"Frassoni","year":"1989","journal-title":"Br J Haematol"},{"key":"B20","doi-asserted-by":"publisher","DOI":"10.1182\/BLOOD.2018874115","article-title":"Total body irradiation dose and risk of subsequent neoplasms following allogeneic hematopoietic cell transplantation","volume":"133","author":"Baker","year":"2019","journal-title":"Blood"},{"key":"B21","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2000.18.2.348","article-title":"New Malignant diseases after allogeneic marrow transplantation for childhood acute leukemia","volume":"18","author":"Soci\u00e9","year":"2000","journal-title":"J Clin Oncol"},{"key":"B22","doi-asserted-by":"publisher","DOI":"10.1016\/J.IJROBP.2005.02.032","article-title":"Dose response and factors related to interstitial pneumonitis after bone marrow transplant","volume":"63","author":"Sampath","year":"2005","journal-title":"Int J Radiat Oncol Biol Phys"},{"key":"B23","doi-asserted-by":"publisher","DOI":"10.1016\/0360-3016(92)90909-2","article-title":"Marrow transplantation following escalating doses of fractionated total body irradiation and cyclophosphamide\u2014a phase I trial","volume":"23","author":"Petersen","year":"1992","journal-title":"Int J Radiat Oncol Biol Phys"},{"key":"B24","doi-asserted-by":"publisher","DOI":"10.1016\/j.radonc.2022.05.027","article-title":"ESTRO ACROP and SIOPE recommendations for myeloablative Total Body Irradiation in children","volume":"173","author":"Hoeben","year":"2022","journal-title":"Radiother Oncol"},{"key":"B25","doi-asserted-by":"publisher","first-page":"295","DOI":"10.1200\/JCO.20.02529","article-title":"Total body irradiation or chemotherapy conditioning in childhood ALL: A multinational, randomized, noninferiority phase III study","volume":"39","author":"Peters","year":"2021","journal-title":"J Clin Oncol"},{"key":"B26","doi-asserted-by":"publisher","DOI":"10.1080\/10428194.2018.1493734","article-title":"Fludarabine, busulfan, and low-dose TBI conditioning versus cyclophosphamide and TBI in allogeneic hematopoietic cell transplantation for adult acute lymphoblastic leukemia","volume":"60","author":"Speziali","year":"2019","journal-title":"Leuk Lymphoma"},{"key":"B27","doi-asserted-by":"publisher","first-page":"110366","DOI":"10.1016\/j.radonc.2024.110366","article-title":"Technical recommendations for implementation of Volumetric Modulated Arc Therapy and Helical Tomotherapy Total Body Irradiation","volume":"197","author":"Seravalli","year":"2024","journal-title":"Radiother Oncol"},{"key":"B28","doi-asserted-by":"publisher","DOI":"10.1111\/petr.13372","article-title":"Ovarian function after allogeneic hematopoietic stem cell transplantation in children and young adults given 8-Gy total body irradiation-based reduced-toxicity myeloablative conditioning","volume":"23","author":"Komori","year":"2019","journal-title":"Pediatr Transplant"},{"key":"B29","doi-asserted-by":"publisher","DOI":"10.1038\/bmt.2015.61","article-title":"Pushing the envelope\u2014nonmyeloablative and reduced intensity preparative regimens for allogeneic hematopoietic transplantation","volume":"50","author":"Pingali","year":"2015","journal-title":"Bone Marrow Transplant"},{"key":"B30","doi-asserted-by":"publisher","DOI":"10.1182\/BLOOD-2014-02-514778","article-title":"Conditioning regimens for hematopoietic cell transplantation: one size does not fit all","volume":"124","author":"Gyurkocza","year":"2014","journal-title":"Blood"},{"key":"B31","doi-asserted-by":"publisher","DOI":"10.3389\/fonc.2022.1044539","article-title":"Long-term follow up of patients with hematological Malignancies treated with total body irradiation using intensity modulated radiation therapy","volume":"12","author":"Ladbury","year":"2022","journal-title":"Front Oncol"},{"key":"B32","doi-asserted-by":"publisher","DOI":"10.1016\/j.bbmt.2019.08.012","article-title":"Comparison of high doses of total body irradiation in myeloablative conditioning before hematopoietic cell transplantation","volume":"25","author":"Sabloff","year":"2019","journal-title":"Biol Blood Marrow Transplant"},{"key":"B33","doi-asserted-by":"publisher","DOI":"10.1038\/s41409-020-0799-3","article-title":"Total body irradiation (18\u2009Gy) without chemotherapy as conditioning for allogeneic hematopoietic cell transplantation in refractory acute myeloid leukemia","volume":"55","author":"Altouri","year":"2020","journal-title":"Bone Marrow Transplant"},{"key":"B34","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2016.06.2459","article-title":"Evaluation of functional marrow irradiation based on skeletal marrow composition obtained using dual-energy computed tomography","volume":"96","author":"Magome","year":"2016","journal-title":"Int J Radiat Oncol Biol Phys"},{"key":"B35","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2012.03.033","article-title":"Dose escalation of total marrow irradiation with concurrent chemotherapy in patients with advanced acute leukemia undergoing allogeneic hematopoietic cell transplantation","volume":"85","author":"Wong","year":"2013","journal-title":"Int J Radiat Oncol Biol Phys"}],"container-title":["Frontiers in Oncology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fonc.2025.1695178\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,9]],"date-time":"2026-01-09T05:14:54Z","timestamp":1767935694000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fonc.2025.1695178\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,9]]},"references-count":35,"alternative-id":["10.3389\/fonc.2025.1695178"],"URL":"https:\/\/doi.org\/10.3389\/fonc.2025.1695178","relation":{},"ISSN":["2234-943X"],"issn-type":[{"value":"2234-943X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,9]]},"article-number":"1695178"}}