EDU 08 - Radiotherapy for Leukemia: Past, Present and Future
MODERATOR(S)
Sarah Milgrom, MD - University of Colorado School of Medicine
Colton Ladbury, MD, BS - City of Hope National Medical Center
session DESCRIPTION
The use of radiotherapy (RT) in the management of leukemia has evolved. Historically, RT was critical for disease control in sanctuary sites, such as the central nervous system (CNS) and testes. However, modern chemotherapy is highly effective, even within sanctuary sites, so RT utilization has declined substantially. Nonetheless, RT maintains some important roles. For example, in young patients with acute lymphoblastic leukemia undergoing stem cell transplantation (SCT), a total body irradiation (TBI)-based preparative regimen has been associated with improved survival, when compared to myeloablative chemotherapy regimens. Historically, TBI was delivered using static, parallel opposed photon beams (2D-TBI); however, recently, centers have increasingly used intensity modulated radiation therapy (IMRT) techniques. Relative to 2D-TBI, IMRT can reduce doses to critical organs while delivering myeloablative doses to the rest of the body, so it may decrease the risk of toxicity while maintaining oncologic outcomes. Multi-organ-sparing, dose-escalated total marrow irradiation (TMI) and total marrow/lymphoid irradiation (TMLI) are related concepts that aim to reduce toxicity and increase efficacy in patients without standard SCT options, including those with persistent, chemorefractory disease. IMRT-based TBI, as well as TMI/TMLI, may continue to expand and redefine how RT is used as a part of leukemia therapy.
learning objectives
- Explain how and why indications for radiotherapy in leukemias have changed with time.
- Describe the potential advantages, as well as the challenges, of delivering total body irradiation using conformal techniques.
- Discuss potential future applications of radiotherapy in the management of leukemia, including total marrow irradiation and total marrow/lymphoid irradiation.
Credits
| AMA PRA Category 1 Credits: | 1.25 |
| CAMPEP Credits: | 1.25 |
| MDCB Credits: | 1.25 |
Presentations
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04:45pm - 04:47pm PTSpeaker: Sarah Milgrom, MD - University of Colorado School of Medicine, Aurora
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04:47pm - 05:02pm PTSpeaker: Susan Wu, MD - MD Anderson Cancer Center, Houston
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05:02pm - 05:17pm PTSpeaker: Susan Hiniker, MD - Stanford University, Stanford
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05:17pm - 05:32pm PTSpeaker: Nataliya Kovalchuk, PhD - Stanford University School of Medicine, Palo Alto
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05:32pm - 05:47pm PTSpeaker: Jeffrey Wong, MD, FASTRO - City of Hope National Medical Center, Duarte
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05:47pm - 06:00pm PTSpeaker: Colton Ladbury, MD, BS - City of Hope National Medical Center, Duarte