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Introduction: Total body irradiation (TBI) with megavolt photon energy is a treatment that can be applied before bone marrow transplantation (BMT) in many hematologic diseases. Two-dimensional TBI (2D-TBI) is one of the oldest RT techniques. We performed a retrospective study to evaluate the radiotherapy (RT)-related acute adverse events in pediatric patients with TBI. Methods: Patients who received TBI between January 1, 2021, and December 30, 2021, in the Radiation Oncology Clinic of Ankara City Hospital were evaluated retrospectively. The primary endpoint of the study was the assessment of RT-related acute adverse events (RT-AE). The Common Terminology Criteria for Adverse Events (CTCAE) version 5.0 was used for RT-AE. Results: Twenty-one pediatric patients treated with 2D-TBI between February 20, 2021, and October 10, 2021, have been retrospectively analyzed. The median follow-up period is 7 (range 1-14) months. The median age of the patients is 11 (range 2-17) years. The median time to BMT following TBI is 4 (range 3-13) days. A total of 12 Gy was applied to 15 (71.4%) patients diagnosed with acute lymphoblastic leukemia and acute myeloid leukemia. A total of 3 Gy was applied to 5 (23.8%) patients due to aplastic anemia and thalassemia major. A total of 4 Gy was applied to 1 (4.8%) patient who had anaplastic large cell lymphoma. In the first week after TBI, all 21 (100%) patients were neutropenic in grade 3 or higher. One day after TBI, there was a 23.4% increase in grade 3 or higher leukopenia [p=0.042; OR (95% CI) 0.278 (0.132-0.585)]. Discussion and Conclusion: The 2D-TBI is applied with acceptable toxicity. TBI-related pneumonia was not observed in any of the patients in our treatment technique with a dose/rate of 0.053 Gy/min. [ABSTRACT FROM AUTHOR]

Objective: Anthracyclines are widely used in the treatment of acute lymphoblastic leukemia (ALL). However, cardiotoxicity is the most critical side effect that requires dose limitation. It is thought to occur at first exposure, but the clinical presentation may occur years later. In this study, we aimed to determine the time of initial damage and cardiotoxicity that develops in children with ALL. Methods: In this prospective study, 13 patients with newly diagnosed intermediate-risk precursor B cell ALL treated with the ALL-IC BFM 2009 protocol were included. Conventional echocardiography, tissue Doppler imaging (TDI), and speckle-tracking echocardiography (STE) were performed in all the patients before chemotherapy, after completing the induction phase, and at the end of the reinduction phase. Results: The mean age of the patients was 7.8±4.6 (3.1–16.3) years. Myocardial velocity during systole (Sm) determined by TDI at the interventricular septum significantly decreased during the induction phase. Despite a decrease in STE parameters, a statistically significant reduction was determined in the global longitudinal strain rate at both left and right ventricles at the end of the induction. Nevertheless, a statistically significant increase was observed among the conventional echocardiographic findings in the left ventricular end-diastolic diameter at the end of the reinduction. Conclusion: During the treatment of ALL, subclinical anthracycline-associated cardiotoxicity develops in the early stages of treatment. The findings detected by TDI and STE could be missed by conventional echocardiography. We recommend evaluating patients with these newly developed techniques to detect subclinical cardiotoxicity at an early stage and starting appropriate therapy on time. [ABSTRACT FROM AUTHOR]