Evolution of treatment planning and dose delivery methods during radiotherapy for patients undergoing bone marrow transplantation : a review

Background and objectives: This study describes the treatment planning and dose delivery methods of radiotherapy for patients undergoing bone marrow transplantation. The analysis was carried out in the context of the evolution of these methods over the last 60 years. Materials and methods: A systematic literature search was carried out using the PubMed search engine. Overall, 90 relevant studies were included: 24 general studies, 10 describing isotopes usage, 24 related to conventional and 32 to advanced methods. Results: The analysis of the evolution of radiotherapy methods shows how signifi cantly the precision of dose planning methods and its delivery have changed. The atypical positioning caused by geometrical requirements for applications of isotopes or conventional techniques has been replaced by positioning on a therapeutic couch, which allows a more precise setup of the patient that is necessary for an exact delivery of the planned dose. The dose can be fully optimized and calculated on tomographic images by algorithms implemented in planning systems. Optimization process allows to reduce doses in organs at risk. The accuracy between planned and delivered doses can be checked by pretreatment verifi cation methods, and the patient positioning can be checked by image guidance procedures. Interpretation and conclusions: Current radiotherapy solutions allow a precise delivery of doses to the planning target volume while reducing doses to organs at risk. Nevertheless, it should be kept in mind that establishing radiotherapy as an important element of the whole therapeutic regimen resulted from the follow-up of patients treated by conventional techniques. To confi rm the clinical value of new advanced techniques, clinical trials are required.