VI. CONCLUSION: REPORTING TOTAL BODY IRRADIATION |
It was the goal to support careful determination, clear recording and uniform reporting of the most relevant physical parameters of TBI in order to eneble prospective an retrospective clinical trials. As BMT is a very complex treatment these physical parameters of TBI alone are no suited for any evaluation of clinical BMT results. For all retrospective studies the data must have been collected with the recommended form. Redocumentation of previous treatments may be difficult or impossible.
We hope that the efforts of so many contributing experts will give better knowledge and indicate ways of further improvements of this successful treatment.
As stated previously, the clinical data have been registered in a standardized way over many years as a data base of the EBMT and IBMT registries. There is an increasing number of papers, conferences and task groups that now ask for the inclusion of physical data into this data base. This is necessary for retrospective and prospective studies for the evaluation of clinical data.
In this sense, and according to the existing literature and the comments and criticism made by some experts from all over Europe, the following set of data is proposed to be included into the data base of the EBMT and IBMT registries.
Reporting TBI in MED B
The MED A-B[55] is a clinical protocol of the Eurpean group for Blood and Marrow Transplantation (EBMT) for registration of Minimum Essential Data for Allogeneic or autologous stem cells transplantation. MED A, only one page, one per transplantation performed, while MED-B contains one questionaire per disease, one per transplantation procedure and now, one additional questionaire for Total Body Irradiation (see form).
The main part of the page regards the physical parameters of TBI and has to be filled by the radiophysicists responsible for TBI. The headings (only seven lines) concerns administrative and clinical data. In order to fulfill the general requirements of this protocol, some minor changes or adjustments have been made to the form printed in the EBMT-brochure[56]:
-TimingThe clinical and biological effects of TBI and chemotherapy depend to a great extent on their temporal administration[54]. That is why the starting chemotherapy date has been included in the headings.
-Organ doses (target volume) if varing from TBI dose by ±10% due to shielding or additional beams during the course of treatment.
Spleen.-
Rib cage.- The relative volume of ribs receiving a modified dose has to be estimated.
The open field (number 3) is intended for suggestions of additional organs to be included in future, if necesary. This field cannot be evaluated at the moment.
-Organ doses (normal tissue, other organs at risk) if varying from the TBI dose by ±10% due to shielding or additional beams during the course of treatment.
Eye lenses.-
Kidneys.-
C.N.S.- The shole Central Nervous System including brain and spinal cord.
The open field (number 4) is intended for suggestions of additional organs to be included in future, if necessary.
-Comments: For next upgrades of this form, we need your suggestions about which part of the target volume (e.g. testes, brain, mediastinum) should be included in section I and which other organs at risk in section III should be considered.
Please state previous radiotherapy with dates, fractions and doses in the comments field.