Total Body Irradiation (TBI)is an Efficient Treatment for leukemia

In the past year, a new cancer treatment technique was launched at MAHAK Pediatric Cancer Treatment and Research Center (MPCTRC). Total Body Irradiation (TBI) delivers radiation to the whole body from head to toe. It destroys remaining malignant cells, creates space in bone marrow for donor’s bone marrow stem cells and prevents rejection by suppressing patient’s immune system. TBI increases the survival rate in children with high-risk leukemia.

To date, MAHAK has been able to introduce this advanced technique to the Iranian medical community for the first time in order to integrate cancer treatment with international standards. Therefore, we have had an interview with Mithra Ghalibafian, M.D., radiation oncologist and head of Radiation Oncology Department of MAHAK Hospital.

To elaborate on the technique, she stated: “Total Body Irradiation (TBI) is a part of the preparation procedure for hematopoietic (or bone marrow) stem cell transplantation. In this method, the immune system of the individual who needs transplantation gets suppressed allowing the recipient to accept foreign bone marrow stem cells. Moreover, it can eradicate the remaining cancer cells and thereby increase survival rates of high-risk leukemia patients”.

TBI is always given in conjunction with intensive chemotherapy to increase its effects on the immune system and remaining leukemia cells.

Consequently, children must subsequently be hospitalized in transplantation ward sterile rooms to reduce risks of serious infections.  Medical and non-medical personnel such as family members must wear mask, surgery gowns and shoe cover and abide by strict protocols required in such environments.

TBI and intensive chemotherapy are particularly efficient in children with high-risk leukemia

During TBI, the amount of radiation delivered to patients is continuously measured by recording radiation entering and exiting the body and lungs are protected by lead blocks placed between the linear accelerator and the patient. TBI and intensive chemotherapy are the gold standard for treating children with high-risk acute leukemia. Briefly enumerating the late side effects and advantages of TBI over other methods, she stated: “TBI can cause late complications such as cataract, secondary tumors and infertility. These effects are likely due to the combination of irradiation and chemotherapy.

TBI is delivered over one week

Regarding the duration of the treatment, the head of MAHAK Hospital’s Radiation Oncology Department stated that the whole treatment takes a week. Treatment is performed every day and each session last about 4 hours. Sometimes it can be performed twice a day, depending on patient’s physical condition and facility availabilities.

TBI requires close interdisciplinary cooperation between a radiation oncologist, a medical physicist, two radiation therapists and a radiographer (for simultaneous imaging during the treatment with a portable device).

Prior to TBI, multiple precise measurements of different body parts of children are performed from a CT scan, radiation dose estimates are calculated by the physicist and individual shielding blocks for lung protection are produced.

At the end of our conversation, Ghalibafian highlighted the importance of mental health in children and their families during treatment. She added: “Since this sort of treatment is unfamiliar, challenging and presenting risks to children, the presence of psychologists and social workers to support children and their families is of paramount importance during the irradiation process.

TBI is a method which has been used across the globe for decades and is now mostly reserved for high-risk leukemia in need of transplantation. Using this type of irradiation in Iran would increase survival rate of children with high-risk leukemia.”

MAHAK has always strived to provide the best and the most updated treatments and support services for cancer-stricken children and their families in accordance with international standards. This endeavor which has for the past 29 years befitted over 35000 children has been made possible due of the support of volunteers and benefactors.