00:00I am Dr. Ian Vaidisharan, Director and Senior Consultant in Oncology, Kaveri Cancer Institute, Kaveri Hospitals, Alwarpet Chennai.
00:09We are proud to tell you that we have started BMT programs in our hospital.
00:15Today, I am going to talk to you about Total Marrow and Lymphoid Radiation, TMLI,
00:21which is a new concept of treatment of radiating the marrow and the lymphoid tissue to abelate the cells in these areas.
00:30When do we do TMLI?
00:32TMLIs or Total Marrow and Lymphoid Radiations are done for refractory AMLs,
00:39people who undergo bone marrow transplantations or BMT.
00:42Now, before telling about TMLI, I would like to state that previously we were doing Total Body Radiation,
00:50the Total Body Radiation disadvantage for this technique is that we are radiating the entire body,
00:56including the structures, that is normal structures.
00:59In TMLI, which is Total Marrow and Lymphoid Radiation,
01:04not only we radiate the marrow and the lymphoid tissue,
01:07we are able to selectively spare the normal structures in the body,
01:13namely the lung, the heart, the oral cavity, the kidneys, etc.
01:19So, when you are selectively trying to radiate only the marrow and the lymphoid tissue,
01:25you have a better tolerance for the radiation and a better abelation of the marrow.
01:30This is a part of the program of the BMT because in a BMT,
01:35we have to abelate the marrow that the bad cells which are in the marrow have to be totally destroyed
01:40and the new cells are incorporated into the system or infused into the system of the patient
01:45by an allogenic blood collected from a donor and re-infused into the body of the patient
01:51or into the marrow of the patient.
01:53So, new cells are formed during the next process
01:56when totally the entire marrow has been destroyed with all the bad cells.
01:59How do you go about this process?
02:01It's a very cumbersome process.
02:02It's a very time-consuming process which I will tell you.
02:04Patient is selected according to the nature or discussed with the medical oncologist
02:10or the hematologist and hemato-oncologist and the radiation oncologist.
02:14The patient selection is being done.
02:16Patients with refractory abelial who want to have a bone marrow transplant
02:19as a second line of treatment are selected.
02:22Patient lies down in this kind of a special backlog.
02:25It's called a whole body backlog.
02:26It's totally different from the regular backlog.
02:28That is the leg of the patient.
02:30The entire body is immobilized and also the head is immobilized.
02:32So, the process is the entire body of the patient is totally immobilized
02:36during the process of this treatment.
02:39Why?
02:40Because when there is a movement, you may miss it.
02:42Areas of the marrow and the lymphoid tissue
02:44because you're selectively treating a small structure
02:46in the marrow as well as lymphoid tissue.
02:49Now, looking at this, we do a CT scan, entire CT scan of the body.
02:53And after doing the CT scan, we draw the critical structures.
02:58What will be the structures?
02:59The marrow and the lymphoid tissue has to be drawn.
03:02Not only that, we have to draw all the organs, namely the heart,
03:06the brain, the lung, the kidneys, the stomach, liver, spleen, everything is drawn.
03:12So, the idea of the whole technology is to radiate selectively the entire marrow,
03:20destroying the marrow and the lymphoid tissue.
03:22We deliver it twice a day for five days, something like 1500 centigrade.
03:28We deliver over a period of 10 fractions.
03:30This is the idea of the treatment.
03:33And during the process of every treatment,
03:35we will check or verify the entire body.
03:39You can't treat the entire body in one stretch.
03:41So, we have to divide the body into various sections.
03:45So, we have about five to six sections of body being divided.
03:49And each section, the arc or the machine rolls down and treats the patient.
03:53Before treating the patient, the verification is done and the matching is done so that
03:58the precision of first field and the second field is absolutely matched.
04:02Otherwise, you may get an overdose.
04:04This is the distribution of the patient where this color represents all the area to be radiated.
04:11This is the anteroposter view and this is the lateral view.
04:14Treating the entire marrow and the lymphoid tissue.
04:16This is how the patient is being positioned and the machine rolls down 360 degrees to treat
04:22the entire patient.
04:23As I was telling you, we have divided the patient into various sections.
04:26First section, second section, third section, fourth section, fifth and sixth section.
04:30So, six divisions have been done for the entire patient.
04:33And each division or each portion is matched with the other.
04:37So, that exact matching takes place and overdose doesn't take place.
04:40This is how the rotation goes on.
04:41So, the entire treatment takes about nearly one to one and a half hours is the total duration
04:47of one treatment.
04:48So, looking at it, morning one and a half hours to two hours and evening one and a half hours
04:52to two hours depending on the situation.
04:54So, patient is lying down in this couch.
04:56The machine is totally immobilized.
04:59Machine rolls for a 360 degrees angle, goes to the entire treatment from the head to the foot.
05:05That is the concept of total lymphoid and marrow radiation.
05:08Very tolerable to the patient, very encouraging results with BMT, especially refractory ALS.
05:14We have started this program and we are proud to say that we will be in the future, we will
05:18be having a large amount of patients being treated with TMLIs.
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