L'irradiation corporelle totale, un complement a la chimiotherapie contre la leucemie: Aspects techniques et optimisation de la dose

Abstract

L'irradiation corporelle totale est souvent necessaire dans les cas de leucemie, pour eviter les risques de rejet de greffe de moelle osseuse et controler les cellules cancereuses. Le patient est deplace horizontalement sur une table motorisee sous le faisceau de radiation. Afin d'uniformiser la dose, la distribution des vitesses de deplacement est optimisee en tenant compte de la geometrie du patient. Chaque changement de vitesse est deduit de la determination des ponderations d'un grand nombre de faisceaux. Cette approche innovatrice, tirant profit du logiciel de planification Theraplan^PLUS, donne des resultats superieurs a la technique conventionnelle a vitesse constante. En effet, la variation de dose atteint plus de 12% avec une vitesse constante, mais demeure bien inferieure a 3% avec une optimisation des vitesses. Les applications cliniques ont ete le point culminant de tout le projet, avec un premier patient traite avec cette nouvelle technique en juillet 1998.

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Total body irradiation is often necessary in cases of leukemia, to avoid the risk of bone marrow transplant rejection and to control cancer cells. The patient is moved horizontally on a motorized table under the radiation beam. In order to standardize the dose, the distribution of movement speeds is optimized taking into account the geometry of the patient. Each change in speed is deduced from the determination of the weightings of a large number of beams. This innovative approach, taking advantage of Theraplan^PLUS planning software, provides superior results to the conventional constant speed technique. Indeed, the dose variation reaches more than 12% with a constant speed, but remains well below 3% with speed optimization. Clinical applications were the highlight of the entire project, with the first patient treated with this new technique in July 1998.