Radiotherapy as an Immunosuppressive Agent for Allotransplantation: Literature Review and Clinical Experience - Past, Present, and Future

Chuleeporn Jiarpinitnun; Thiti Swangsilpa; Puangpen Tangboonduangjit; Rasin Worawongsakul; Orawan Rattanasuwan

doi:10.14456/rmj.2018.26

Authors

Chuleeporn Jiarpinitnun Department of Radiology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
Thiti Swangsilpa Department of Radiology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
Puangpen Tangboonduangjit Department of Radiology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
Rasin Worawongsakul Department of Radiology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
Orawan Rattanasuwan Department of Radiology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand

DOI:

https://doi.org/10.14456/rmj.2018.26

Keywords:

Allotransplantation, Total lymphoid irradiation, Total body irradiation, Total marrow irradiation, Total marrow and lymphoid irradiation

Abstract

Radiotherapy could function as immunosuppressive agent for allotransplantation due to the ability of ionizing radiation to cause cell death, the technique could be applied to irradiate total body, bone marrow and/or lymphoid tissues of the recipient who receive an allograft as an immunosuppressant to improve the success rate of transplantation. From the past to the present, the radiation techniques in allotransplantation process have been continuously studied and developed across preclinical and clinical settings, in order to achieve better therapeutic outcomes. Currently, total lymphoid irradiation by fractionation and total body irradiation with low dose are most frequently used radiotherapy techniques in allotransplantation process. The advanced radiotherapy techniques such as total marrow and/or lymphoid irradiation by volumetric arc therapy (VMAT) or helical tomotherapy (HT) have gained interests. These advanced techniques could increase therapeutic ratio by improving conformity high radiation dose to the targets and reducing dose to the surrounding normal tissues. This review aims to provide the insights of radiotherapy applications as an immunosuppressive agent for allotransplantation and to share clinical experiences and outcomes.

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