Long-term complications of total body irradiation in adults

Purpose: To report long-term pulmonary, thyroid, and ocular complications i n patients who had conditioning regimens including total body if radiation (TBI) before bone marrow transplantation (BMT). Methods and Materials: Between June 1986 and December 1995, 478 patients re ceived TBI in our institution. The present study includes 186 adult patient s who had complete remission lasting one year or more after BMT. There were 108 males and 78 females. Median age was 36.5 years (range 15-60). Initial diagnoses were lymphomas (50%), acute lymphoid leukemias (16%), acute myel oid leukemias (16%), chronic myeloid leukemia (13%), aplastic anemia (3%), and myelodysplasia (2%). At the time of BMT, 43.5% of patients were in comp lete response and 56.5% in partial response. Treatment consisted of a singl e dose TBI at 10 Gy in 9% and fractionated TBI delivering 12 to 13.5 Gy in 6 fractions in 91%. From 1986 to October 1991, TBI was performed in lateral position with 9 MV energy (57% of patients) and thereafter in alternate pr one and supine positions with 15 MV energy (43%). Chemical conditioning reg imen was cyclophosphamide (60 mg/kg at D-4 and D-3) in 69% and CBV (cycloph osphamide 1500 mg/m(2) from D-6 to D-3, BCNU 300 mg/m(2) at D-6, VP-16 200 mg/m(2) from D-6 to D-4) in 25%. Fifty eight percent of patients received a utologous and 42% allogeneic BMT. All patients had clinical, biologic, and functional examinations at one-year intervals. Results: Median follow-up from BMT was 49 months (range 12-136). Late pulmo nary effects were observed only in functional explorations, without clinica l effect, including restrictive syndrome in 8% and alteration in the diffus ing capacity of carbon monoxide in 12%. No patient showed clinical thyroid symptoms, and 10% developed biologic dysfunction: hypothyroidism (6.5%), th yroiditis (3%), and Basedow disease (0.5%). Ocular complications occurred i n 29.5%, including cataract (15%), dry syndrome (13%), and keratitis (1.5%) . In univariate and multivariate analysis, pulmonary complications were sta tistically increased by chronicle graft vs. host disease (GVHD) vs. no (p = 0.02), prone and supine vs. lateral TBI position (p = 0.02), and with 15 M V vs. 9 MV beam energy (p = 0.02), Cataract occurred less frequently with f ractionated than with single-dose TBI (p = 0.000002). No differences were o bserved regarding age, sex, initial diagnosis, status at the time of BMT, c onditioning chemotherapy regimen, and total dose of TBI. Conclusion: From this retrospective study it was shown that long-term compl ications of TBI were not symptomatic in most patients. The role of paramete rs of irradiation and especially position of treatment and beam energy shou ld be emphasized and assessed with a longer follow-up. (C) 2001 Elsevier Sc ience Inc.