{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T16:24:40Z","timestamp":1789575880049,"version":"build-2803163510"},"reference-count":63,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2025,8,22]],"date-time":"2025-08-22T00:00:00Z","timestamp":1755820800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: Total body irradiation (TBI) remains a cornerstone of conditioning for allogeneic haematopoietic stem-cell transplantation (HSCT). Whereas early research debated the need for irradiation, contemporary investigations focus on optimising dose, fractionation and delivery techniques. Material and Methods: We synthesised six decades of evidence, spanning from single-fraction cobalt treatments to modern helical tomotherapy and intensity-modulated total-marrow\/lymphoid irradiation (TMI\/TMLI). To complement the literature, we reported our institutional experience on 77 paediatric and adult recipients treated with conventional extended-source-to-skin-distance TBI at the University Hospital Policlinico \u201cG. Rodolico\u2013San Marco\u201d between 2015 and 2025. Results: According to literature data, fractionated myeloablative schedules, typically 12 Gy in 6 fractions, provide superior overall survival and lower rates of severe graft-versus-host disease (GVHD) compared with historical single-dose regimens. Conversely, reduced-intensity protocols of 2\u20134 Gy broaden HSCT eligibility for older or comorbid patients with acceptable toxicity. Conformal planning reliably decreases mean lung dose without compromising engraftment, and early-phase trials are testing selective escalation to 16\u201320 Gy or omission of TBI in molecularly favourable cases. With regard to our institutional retrospective series, 92% of patients completed a 12-Gy regimen with only transient grade 1\u20132 nausea, fatigue or hypotension; all transplanted patients engrafted, and no grade \u2265 3 radiation pneumonitis occurred. Conclusions: Collectively, the published evidence and our experience support TBI as an irreplaceable component of HSCT conditioning and suggest that coupling it with advanced imaging, organ-sparing dosimetry and molecular response monitoring can deliver safer, more personalised therapy in the coming decade.<\/jats:p>","DOI":"10.3390\/medicina61091503","type":"journal-article","created":{"date-parts":[[2025,8,22]],"date-time":"2025-08-22T11:50:31Z","timestamp":1755863431000},"page":"1503","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Total Body Irradiation in Haematopoietic Stem Cell Transplantation: A Comprehensive Literature Review and Institutional Experience from the Policlinico of Catania"],"prefix":"10.3390","volume":"61","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4294-7350","authenticated-orcid":false,"given":"Maria Chiara","family":"Lo Greco","sequence":"first","affiliation":[{"name":"Radiation Oncology Unit, Department of Biomedical, Dental and Morphological and Functional Imaging Sciences, University of Messina, 98122 Messina, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3282-2204","authenticated-orcid":false,"given":"Roberto","family":"Milazzotto","sequence":"additional","affiliation":[{"name":"Radiation Oncology Unit, University Hospital Policlinico \u201cG. Rodolico-San Marco\u201d, 95123 Catania, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Grazia","family":"Acquaviva","sequence":"additional","affiliation":[{"name":"Radiation Oncology Unit, University Hospital Policlinico \u201cG. Rodolico-San Marco\u201d, 95123 Catania, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-0458-601X","authenticated-orcid":false,"given":"Rocco Luca Emanuele","family":"Liardo","sequence":"additional","affiliation":[{"name":"Radiation Oncology Unit, University Hospital Policlinico \u201cG. Rodolico-San Marco\u201d, 95123 Catania, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-1036-9965","authenticated-orcid":false,"given":"Giorgia","family":"Marano","sequence":"additional","affiliation":[{"name":"Radiation Oncology Unit, Department of Biomedical, Dental and Morphological and Functional Imaging Sciences, University of Messina, 98122 Messina, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7933-3056","authenticated-orcid":false,"given":"Madalina","family":"La Rocca","sequence":"additional","affiliation":[{"name":"Radiation Oncology Unit, Department of Biomedical, Dental and Morphological and Functional Imaging Sciences, University of Messina, 98122 Messina, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonio","family":"Basile","sequence":"additional","affiliation":[{"name":"Department of Medical Surgical Sciences and Advanced Technologies \u201cG.F. Ingrassia\u201d, University of Catania, 95123 Catania, Italy"},{"name":"Radiology I Unit, University Hospital Policlinico \u201cG. Rodolico-San Marco\u201d, 95123 Catania, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0918-0103","authenticated-orcid":false,"given":"Pietro Valerio","family":"Foti","sequence":"additional","affiliation":[{"name":"Department of Medical Surgical Sciences and Advanced Technologies \u201cG.F. Ingrassia\u201d, University of Catania, 95123 Catania, Italy"},{"name":"Radiology I Unit, University Hospital Policlinico \u201cG. Rodolico-San Marco\u201d, 95123 Catania, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7196-2974","authenticated-orcid":false,"given":"Stefano","family":"Palmucci","sequence":"additional","affiliation":[{"name":"Department of Medical Surgical Sciences and Advanced Technologies \u201cG.F. Ingrassia\u201d, University of Catania, 95123 Catania, Italy"},{"name":"Radiology I Unit, University Hospital Policlinico \u201cG. Rodolico-San Marco\u201d, 95123 Catania, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emanuele","family":"David","sequence":"additional","affiliation":[{"name":"Department of Medical Surgical Sciences and Advanced Technologies \u201cG.F. Ingrassia\u201d, University of Catania, 95123 Catania, Italy"},{"name":"Radiology I Unit, University Hospital Policlinico \u201cG. Rodolico-San Marco\u201d, 95123 Catania, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7529-2680","authenticated-orcid":false,"given":"Corrado","family":"In\u00ed","sequence":"additional","affiliation":[{"name":"Department of Medical Surgical Sciences and Advanced Technologies \u201cG.F. Ingrassia\u201d, University of Catania, 95123 Catania, Italy"},{"name":"Radiology I Unit, University Hospital Policlinico \u201cG. Rodolico-San Marco\u201d, 95123 Catania, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9331-3441","authenticated-orcid":false,"given":"Lorenzo","family":"Aliotta","sequence":"additional","affiliation":[{"name":"Department of Medical Surgical Sciences and Advanced Technologies \u201cG.F. Ingrassia\u201d, University of Catania, 95123 Catania, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vincenzo","family":"Salamone","sequence":"additional","affiliation":[{"name":"U.O.S.D. Fisica Sanitaria, University Hospital Policlinico \u201cG. Rodolico-San Marco\u201d, 95123 Catania, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Viviana Anna","family":"La Monaca","sequence":"additional","affiliation":[{"name":"U.O.S.D. Fisica Sanitaria, University Hospital Policlinico \u201cG. Rodolico-San Marco\u201d, 95123 Catania, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4696-7634","authenticated-orcid":false,"given":"Stefano","family":"Pergolizzi","sequence":"additional","affiliation":[{"name":"Radiation Oncology Unit, Department of Biomedical, Dental and Morphological and Functional Imaging Sciences, University of Messina, 98122 Messina, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5562-189X","authenticated-orcid":false,"given":"Corrado","family":"Spatola","sequence":"additional","affiliation":[{"name":"Radiation Oncology Unit, University Hospital Policlinico \u201cG. Rodolico-San Marco\u201d, 95123 Catania, Italy"},{"name":"Department of Medical Surgical Sciences and Advanced Technologies \u201cG.F. Ingrassia\u201d, University of Catania, 95123 Catania, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,8,22]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"138","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":"ref_2","doi-asserted-by":"crossref","first-page":"20777","DOI":"10.1073\/pnas.1218913109","article-title":"E. Donnall Thomas (1920\u20132012)","volume":"109","author":"Blume","year":"2012","journal-title":"Proc. Natl. Acad. Sci. USA"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1035","DOI":"10.1038\/1681035a0","article-title":"1,000-Curie Cobalt 60 Units for Radiation Therapy","volume":"168","author":"Johns","year":"1951","journal-title":"Nature"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"903","DOI":"10.3390\/curroncol28010089","article-title":"Total Body Irradiation for Hematopoietic Stem Cell Transplantation: What Can We Agree on?","volume":"28","author":"Sabloff","year":"2021","journal-title":"Curr. Oncol."},{"key":"ref_5","first-page":"18","article-title":"Cobalt 60 versus 15 MeV photons during total body irradiation: Doses in the critical organs and complexicity of the procedure","volume":"6","author":"Malicki","year":"2001","journal-title":"Ann. Transplant."},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Chiang, Y., Tsai, C.H., Kuo, S.H., Liu, C.Y., Yao, M., Li, C.C., Huang, S.Y., Ko, B.S., Lin, C.T., and Hou, H.A. (2016). Reduced incidence of interstitial pneumonitis after allogeneic hematopoietic stem cell transplantation using a modified technique of total body irradiation. Sci. Rep., 6.","DOI":"10.1038\/srep36730"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"207","DOI":"10.3857\/roj.2020.00528","article-title":"Total marrow and lymphoid irradiation with helical tomotherapy: A practical implementation report","volume":"38","author":"Chilukuri","year":"2020","journal-title":"Radiat. Oncol. J."},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Hoeben, B.A.W., Wong, J.Y.C., Fog, L.S., Losert, C., Filippi, A.R., Bentzen, S.M., Balduzzi, A., and Specht, L. (2021). Total Body Irradiation in Haematopoietic Stem Cell Transplantation for Paediatric Acute Lymphoblastic Leukaemia: Review of the Literature and Future Directions. Front. Pediatr., 9.","DOI":"10.3389\/fped.2021.774348"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"222","DOI":"10.1007\/s00066-006-1468-1","article-title":"Total-body irradiation\u2013Role and indications: Results from the German Registry for Stem Cell Transplantation (DRST)","volume":"182","author":"Heinzelmann","year":"2006","journal-title":"Strahlenther. Onkol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"e55","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. Korean Med. Sci."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"817","DOI":"10.1016\/0360-3016(82)90083-9","article-title":"Marrow transplantation for acute nonlymphoblastic leukemic in first remission using fractionated or single-dose irradiation","volume":"8","author":"Thomas","year":"1982","journal-title":"Int. J. Radiat. Oncol. Biol. Phys."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1607","DOI":"10.1016\/0360-3016(83)90412-1","article-title":"Hyperfractionated total body irradiation for bone marrow transplantation. Results in seventy leukemia patients with allogeneic transplants","volume":"9","author":"Shank","year":"1983","journal-title":"Int. J. Radiat. Oncol. Biol. Phys."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"521","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":"ref_14","doi-asserted-by":"crossref","first-page":"101071","DOI":"10.1016\/j.adro.2022.101071","article-title":"Effect of Testicular Boost in Children with Leukemia Receiving Total Body Irradiation and Stem Cell Transplant: A Single-Institution Experience","volume":"8","author":"Blomain","year":"2022","journal-title":"Adv. Radiat. Oncol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"765","DOI":"10.1007\/s00280-012-1990-z","article-title":"High-dose etoposide in allogeneic stem cell transplantation","volume":"70","author":"Bruserud","year":"2012","journal-title":"Cancer Chemother. Pharmacol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"543","DOI":"10.1038\/sj.bmt.1704198","article-title":"Randomized trial of busulfan vs total body irradiation containing conditioning regimens for children with acute lymphoblastic leukemia: A Pediatric Blood and Marrow Transplant Consortium study","volume":"32","author":"Bunin","year":"2003","journal-title":"Bone Marrow Transplant."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"340","DOI":"10.1200\/JCO.2000.18.2.340","article-title":"Comparison of preparative regimens in transplants for children with acute lymphoblastic leukemia","volume":"18","author":"Davies","year":"2000","journal-title":"J. Clin. Oncol. Off. J. Am. Soc. Clin. Oncol."},{"key":"ref_18","doi-asserted-by":"crossref","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. Off. J. Am. Soc. Clin. Oncol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"442","DOI":"10.1182\/blood.V100.2.442","article-title":"Low-dose total body irradiation followed by allogeneic lymphocyte infusion may induce remission in patients with refractory hematologic malignancy","volume":"100","author":"Ballen","year":"2002","journal-title":"Blood"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"905","DOI":"10.1080\/10428190310001628167","article-title":"Low dose total body irradiation followed by allogeneic lymphocyte infusion for refractory hematologic malignancy\u2014An updated review","volume":"45","author":"Ballen","year":"2004","journal-title":"Leuk. Lymphoma"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"3390","DOI":"10.1182\/blood.V97.11.3390","article-title":"Hematopoietic cell transplantation in older patients with hematologic malignancies: Replacing high-dose cytotoxic therapy with graft-versus-tumor effects","volume":"97","author":"McSweeney","year":"2001","journal-title":"Blood"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1340","DOI":"10.1016\/j.bbmt.2013.06.002","article-title":"Fludarabine and 2-Gy TBI is superior to 2 Gy TBI as conditioning for HLA-matched related hematopoietic cell transplantation: A phase III randomized trial","volume":"19","author":"Kornblit","year":"2013","journal-title":"Biol. Blood Marrow Transplant. J. Am. Soc. Blood Marrow Transplant."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"665.e1","DOI":"10.1016\/j.jtct.2021.04.029","article-title":"Outcomes of Fludarabine, Melphalan and Total Body Irradiation as a Reduced Intensity Conditioning Regimen in Matched Donor Allogeneic Peripheral Blood Stem Cell Transplantation","volume":"27","author":"Modi","year":"2021","journal-title":"Transplant. Cell. Ther."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"384","DOI":"10.1016\/j.bbmt.2009.11.004","article-title":"Low-dose total body irradiation and fludarabine conditioning for HLA class I-mismatched donor stem cell transplantation and immunologic recovery in patients with hematologic malignancies: A multicenter trial","volume":"16","author":"Nakamae","year":"2010","journal-title":"Biol. Blood Marrow Transplant. J. Am. Soc. Blood Marrow Transplant."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"788","DOI":"10.1148\/77.5.788","article-title":"Dosimetry for a total-body irradiation chamber","volume":"77","author":"Jacobs","year":"1961","journal-title":"Radiology"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"266","DOI":"10.1148\/72.2.266","article-title":"Development of a room specifically designed for total-body irradiation","volume":"72","author":"Sahler","year":"1959","journal-title":"Radiology"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"705","DOI":"10.1016\/0360-3016(81)90461-2","article-title":"Cobalt-60 therapy unit for large field irradiation","volume":"7","author":"Leung","year":"1981","journal-title":"Int. J. Radiat. Oncol. Biol. Phys."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"927","DOI":"10.1016\/0360-3016(84)90397-3","article-title":"Modification of a standard cobalt-60 unit for total body irradiation at 150 cm SSD","volume":"10","author":"Peters","year":"1984","journal-title":"Int. J. Radiat. Oncol. Biol. Phys."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"567","DOI":"10.1118\/1.595677","article-title":"Physical treatment planning of total-body irradiation: Patient translation and beam-zone method","volume":"12","author":"Quast","year":"1985","journal-title":"Med. Phys."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1016\/0360-3016(83)90214-6","article-title":"Total body irradiation with a sweeping beam","volume":"9","author":"Pla","year":"1983","journal-title":"Int. J. Radiat. Oncol. Biol. Phys."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"19","DOI":"10.2478\/nuka-2020-0003","article-title":"Evolution of treatment planning and dose delivery methods during radiotherapy for patients undergoing bone marrow transplantation: A review","volume":"65","author":"Litoborska","year":"2020","journal-title":"Nukleonika"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"821","DOI":"10.1016\/0360-3016(94)90355-7","article-title":"Consequences of two different doses to the lungs during a single dose of total body irradiation: Results of a randomized study on 85 patients","volume":"30","author":"Girinsky","year":"1994","journal-title":"Int. J. Radiat. Oncol. Biol. Phys."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1016\/j.tipsro.2017.07.001","article-title":"A simple technique for an accurate shielding of the lungs during total body irradiation","volume":"3\u20134","author":"Mekdash","year":"2017","journal-title":"Tech. Innov. Patient Support Radiat. Oncol."},{"key":"ref_34","first-page":"314","article-title":"Advances in the implementation of helical tomotherapy-based total marrow irradiation with a novel field junction technique","volume":"37","author":"Zeverino","year":"2012","journal-title":"Med. Dosim. Off. J. Am. Assoc. Med. Dosim."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"3214","DOI":"10.1118\/1.2044428","article-title":"Feasibility study of helical tomotherapy for total body or total marrow irradiation","volume":"32","author":"Hui","year":"2005","journal-title":"Med. Phys."},{"key":"ref_36","doi-asserted-by":"crossref","unstructured":"Hui, C., Simiele, E., Lozko, Y., Romero, I., Skinner, L., Binkley, M.S., Hoppe, R., Kovalchuk, N., and Hiniker, S.M. (2024). Volumetric modulated arc therapy total body irradiation improves toxicity outcomes compared to 2D total body irradiation. Front. Oncol., 14.","DOI":"10.3389\/fonc.2024.1459287"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"e477","DOI":"10.1016\/S1470-2045(20)30342-9","article-title":"Total marrow and total lymphoid irradiation in bone marrow transplantation for acute leukaemia","volume":"21","author":"Wong","year":"2020","journal-title":"Lancet. Oncol."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"513","DOI":"10.1177\/153303460600500508","article-title":"Linac-based intensity modulated total marrow irradiation (IM-TMI)","volume":"5","author":"Aydogan","year":"2006","journal-title":"Technol. Cancer Res. Treat."},{"key":"ref_39","doi-asserted-by":"crossref","unstructured":"Dogliotti, I., Levis, M., Martin, A., Bartoncini, S., Felicetti, F., Cavallin, C., Maffini, E., Cerrano, M., Bruno, B., and Ricardi, U. (2024). Maintain Efficacy and Spare Toxicity: Traditional and New Radiation-Based Conditioning Regimens in Hematopoietic Stem Cell Transplantation. Cancers, 16.","DOI":"10.3390\/cancers16050865"},{"key":"ref_40","doi-asserted-by":"crossref","unstructured":"Loginova, A.A., Tovmasian, D.A., Lisovskaya, A.O., Kobyzeva, D.A., Maschan, M.A., Chernyaev, A.P., Egorov, O.B., and Nechesnyuk, A.V. (2022). Optimized Conformal Total Body Irradiation methods with Helical TomoTherapy and Elekta VMAT: Implementation, Imaging, Planning and Dose Delivery for Pediatric Patients. Front. Oncol., 12.","DOI":"10.3389\/fonc.2022.785917"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"58","DOI":"10.1186\/s13014-015-0362-3","article-title":"Intensity-modulated Total Body Irradiation (TBI) with TomoDirect\u2122","volume":"10","author":"Salz","year":"2015","journal-title":"Radiat. Oncol."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"110822","DOI":"10.1016\/j.radonc.2025.110822","article-title":"Rationale, implementation considerations, delineation and planning target objective recommendations for volumetric modulated arc therapy and helical tomotherapy total body irradiation, total marrow irradiation, total marrow and lymphoid irradiation and total lymphoid irradiation","volume":"206","author":"Hoeben","year":"2025","journal-title":"Radiother. Oncol. J. Eur. Soc. Ther. Radiol. Oncol."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"323","DOI":"10.1016\/0360-3016(93)90244-P","article-title":"Radiobiological modeling of combined targeted 131I therapy and total body irradiation for treatment of disseminated tumors of differing radiosensitivity","volume":"27","author":"Amin","year":"1993","journal-title":"Int. J. Radiat. Oncol. Biol. Phys."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"1204","DOI":"10.1259\/bjr.70.840.9505837","article-title":"The radiobiological basis of total body irradiation","volume":"70","author":"Wheldon","year":"1997","journal-title":"Br. J. Radiol."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"676","DOI":"10.1016\/S0344-0338(96)80089-6","article-title":"Apoptosis: Pathophysiology of programmed cell death","volume":"192","author":"Bosman","year":"1996","journal-title":"Pathol. Res. Pract."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"974","DOI":"10.1038\/s41419-022-05408-1","article-title":"Mutant p53 in cancer: From molecular mechanism to therapeutic modulation","volume":"13","author":"Chen","year":"2022","journal-title":"Cell Death Dis."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"33004","DOI":"10.18632\/oncotarget.8844","article-title":"Gli-1\/PI3K\/AKT\/NF-kB pathway mediates resistance to radiation and is a target for reversion of responses in refractory acute myeloid leukemia cells","volume":"7","author":"Li","year":"2016","journal-title":"Oncotarget"},{"key":"ref_48","first-page":"1431","article-title":"Radiation damage repair capacity of primary clonogenic blasts in acute lymphoblastic leukemia","volume":"53","author":"Uckun","year":"1993","journal-title":"Cancer Res."},{"key":"ref_49","doi-asserted-by":"crossref","unstructured":"Lo Greco, M.C., Marletta, G., Marano, G., Fazio, A., Buffettino, E., Iudica, A., Liardo, R.L.E., Milazzotto, R., Foti, P.V., and Palmucci, S. (2023). Hypofractionated Radiotherapy in Localized, Low-Intermediate-Risk Prostate Cancer: Current and Future Prospectives. Medicina, 59.","DOI":"10.3390\/medicina59061144"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"477","DOI":"10.1016\/0360-3016(94)90031-0","article-title":"Single dose versus fractionated total body irradiation before bone marrow transplantation: Radiobiological and clinical considerations","volume":"30","author":"Cosset","year":"1994","journal-title":"Int. J. Radiat. Oncol. Biol. Phys."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"128","DOI":"10.1038\/s41409-024-02481-2","article-title":"Measurable residual disease testing and allogeneic hematopoietic cell transplantation for AML: Adapting Pre-MEASURE to clinical practice","volume":"60","author":"Shaffer","year":"2025","journal-title":"Bone Marrow Transplant."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"253","DOI":"10.1182\/blood.2023023699","article-title":"How I use next-generation sequencing-MRD to plan approach and prevent relapse after HCT for children and adults with ALL","volume":"144","author":"Muffly","year":"2024","journal-title":"Blood"},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"2136","DOI":"10.1016\/j.bbmt.2015.07.018","article-title":"Results of a Multicenter Phase II Trial of Brentuximab Vedotin as Second-Line Therapy before Autologous Transplantation in Relapsed\/Refractory Hodgkin Lymphoma","volume":"21","author":"Chen","year":"2015","journal-title":"Biol. Blood Marrow Transplant. J. Am. Soc. Blood Marrow Transplant."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"1363","DOI":"10.1016\/j.bbmt.2014.05.014","article-title":"Radiolabeled anti-CD45 antibody with reduced-intensity conditioning and allogeneic transplantation for younger patients with advanced acute myeloid leukemia or myelodysplastic syndrome","volume":"20","author":"Mawad","year":"2014","journal-title":"Biol. Blood Marrow Transplant. J. Am. Soc. Blood Marrow Transplant."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"1247","DOI":"10.1038\/s41409-024-02317-z","article-title":"Efficient bone marrow irradiation and low uptake by non-haematological organs with an yttrium-90-anti-CD66 antibody prior to haematopoietic stem cell transplantation","volume":"59","author":"Orchard","year":"2024","journal-title":"Bone Marrow Transplant."},{"key":"ref_56","unstructured":"ClinicalTrials.gov. (2025, June 19). Study Details|TBI Using IMRT (VMAT or Tomotherapy) for the Prevention of Pul Toxicities in Patients Undergoing Donor SCT, Available online: https:\/\/www.clinicaltrials.gov\/study\/NCT04281199."},{"key":"ref_57","unstructured":"ClinicalTrials.gov. (2025, June 19). Total Marrow and Lymphoid Irradiation as Conditioning Regimen Before Hematopoietic Cell Transplantation in Patients with Myelodysplastic Syndrome or Acute Leukemia, Available online: https:\/\/clinicaltrials.gov\/study\/NCT04262843?cond=%22Myelodysplastic%20Syndrome%22&intr=%22Vidarabine%22&viewType=Table&rank=5."},{"key":"ref_58","unstructured":"ClinicalTrials.gov. (2025, June 19). Combination Chemotherapy, Total Body Irradiation, and Donor Blood Stem Cell Transplant in Treating Patients with Secondary Myelofibrosis, Available online: https:\/\/clinicaltrials.gov\/study\/NCT03118492."},{"key":"ref_59","unstructured":"Home|ClinicalTrials.gov (2025, June 19). Chemotherapy, Total Body Irradiation, and Post-Transplant Cyclophosphamide in Reducing Rates of Graft Versus Host Disease in Patients with Hematologic Malignancies Undergoing Donor Stem Cell Transplant, Available online: https:\/\/www.clinicaltrials.gov\/study\/NCT03192397."},{"key":"ref_60","unstructured":"ClinicalTrials.gov. (2025, June 19). The EndRAD Trial: Eliminating Total Body Irradiation (TBI) for NGS-MRD Negative Children, Adolescents, and Young Adults with B-ALL, Available online: https:\/\/clinicaltrials.gov\/study\/NCT03509961."},{"key":"ref_61","unstructured":"ClinicalTrials.gov. (2025, June 19). Study Details|Intensity Modulated Total Marrow Irradiation in Fully Human Leukocyte Antigen (HLA)-Matched and Partially-HLA Mismatched Allogeneic Transplantation Patients with High-Risk Acute Myeloid Leukemia (AML), Chronic Myeloid Leukemia (CML), and Myelodysplastic Syndrome (MDS), Available online: https:\/\/clinicaltrials.gov\/study\/NCT06802315?cond=acute%20leukemia&aggFilters=status:,phase:2."},{"key":"ref_62","unstructured":"ClinicalTrials.gov. (2025, June 19). BMT-06: Study of Intensity Modulated Total Marrow Irradiation (IM-TMI), Available online: https:\/\/clinicaltrials.gov\/study\/NCT04187105."},{"key":"ref_63","unstructured":"ClinicalTrials.gov. (2025, June 19). Study Details|Total Body Irradiation and Astatine-211-Labeled BC8-B10 Monoclonal Antibody for the Treatment of Nonmalignant Diseases, Available online: https:\/\/clinicaltrials.gov\/study\/NCT04083183?term=astatine&rank=3."}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/61\/9\/1503\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T18:33:30Z","timestamp":1760034810000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/61\/9\/1503"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,8,22]]},"references-count":63,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2025,9]]}},"alternative-id":["medicina61091503"],"URL":"https:\/\/doi.org\/10.3390\/medicina61091503","relation":{},"ISSN":["1648-9144"],"issn-type":[{"value":"1648-9144","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,8,22]]}}}