Hypofractionated radiotherapy after breast-conserving surgery: Clinical and dosimetric factors predictive of acute skin toxicity.

PURPOSE: The purpose of this study was to evaluate acute skin toxicity in early breast cancer patients treated with hypofractionated radiotherapy (HFRT) after breast-conserving surgery and to identify factors predictive for grade ≥ 2 acute skin toxicity. MATERIALS AND METHODS: A monocentric retrospective study was carried out using cases treated between December 2017 and November 2020. We analyzed data from 202 patients with early breast cancer treated with 3D hypofractionated RT (40.05 Gy in 15 fractions) to the whole breast with or without regional lymph nodes, followed by 13.35 Gy in 5 fractions to the tumor bed. Acute skin toxicity was monitored during RT according to CTCAE (common toxicity criteria for adverse events) scale. Univariate and multivariate analyses were performed to assess predictive factors of acute skin toxicity. RESULTS: Overall, there was no erythema in 9%, grade 1 erythema in 64.5%, grade 2 in 24%, and grade 3 in 2.5%. No grade 4 erythema was seen. Median delay between RT initiating and maximum skin reaction was 22 days (range 4-44 days). No patient interrupted treatment. In univariate analysis, the rate of acute skin toxicity grade 2---3 (G2-3) was significantly higher for patients with larger tumor size (p = 0.02), body mass index > 27 (p = 0.04), and time between chemotherapy (CT) and RT less than 20 days (p = 0.01). Dosimetric risk factors for acute skin toxicity G2­3 were breast volume > 800 cc (p = 0.000), boost volume > 18 cc (p = 0.002), V105% > 40 cc (p = 0.03), and Dmax > 56 Gy (p = 0.007). CT, trastuzumab, regional lymph node radiation, and age were not correlated with increased skin toxicity. In multivariate analysis, acute skin toxicity correlated with T stage (p = 0.032), breast volume > 800 cc (p = 0.012), boost volume > 18 cc (p = 0.04), and Dmax > 56 Gy (p = 0.035). CONCLUSION: Our results confirm that whole breast with or without lymph nodes hypofractionated RT is safe and well tolerated. The factors strongly associated with a decreased risk of G2­3 skin toxicity are T1, breast volume < 800 c, boost volume < 18 cc, and Dmax < 56 Gy. Long-term follow-up is needed to evaluate late toxicity.

Intimate partner violence after cancer diagnosis: an SOS call.

PURPOSE: The aim of the present study was to measure the frequency and types of IPV among patients with cancer and evaluate risk factors. METHODS: The study was a cross-sectional, questionnaire-based study, conducted between January and April 2022, including 141 patients treated with cancer regardless of gender, site, or stage. We developed the study questionnaire by adapting items from the "WHO multi-country questionnaire on violence against women" and "The Women's Experiences with Battering Scale." Odds ratio (OR) and spearman tests were performed to assess the impact of several factors associated with the reported IPV. RESULTS: Median age was 50 years old, 38.3% were male cancer patients. IPV prevalence was 24.8%, we observed 5 cases of torture (3%). The most common forms of violence were placing severe restriction on certain types of food and clothing in 21%, psychological violence in 20%, exposing intimate information about the patient health status to others in 17%, ignoration in 13.5%, putting restrictions on visiting friends or families in 9.2%, verbal assault in 9.2%, physical violence in 7.9%, and 7.1% racist conducts. Financial violence was rare in 4.3%. There was no difference in the incidence of IPV between man and women. We observed a significant correlation between IPV prevalence and disease stage (19.1% M0 vs 34.6% M1, p=0.04, OR=2.2 [1-4.8]), patient's educational level (48.5% vs 17.6%, p=0.01, OR= 4.4 [1.8-10.2]), and being under ongoing cancer therapy (11.4% vs 30.9%, p=0.013, OR=3.4 [1.2-9.7]) CONCLUSION: Patients were shown to be victims of several forms of IPV regardless of gender.

Understanding COVID-19 vaccine hesitancy and resistance: another challenge in cancer patients.

INTRODUCTION: We aimed to measure the acceptability towards the COVID-19 vaccination in cancer patients and to investigate determinant factors associated with the patient's choice. METHODS: We conducted a cross-sectional survey with a self-administered questionnaire delivered to 329 cancer patients in 3 oncology cancer centers in Tunisia between February-May 2021. Logistic regression was used to evaluate odds ratio predicting patient's intentions toward the vaccine. RESULTS: Acceptance rate was 50.5%, 28.3% (n = 93) reported to definitely refuse the vaccine and 21.2% (n = 70) did not make their decision yet. High educational level, history of comorbidities, history of influenza vaccination in the current season, and patient's opinion about the severity of COVID-19 did not predict vaccine resistance. However, patients who think that the vaccine may interfere with treatment efficacy (OR = 7.28, 95%CI [2.5-12.32]), or may impact cancer outcome (OR = 6.14, 95%CI [2.27-16.7]), were significantly more likely to refuse the vaccine. Patients who disagree that the vaccine is a major weapon against the pandemic (OR = 6.07, 95%CI [2.34-9.52]) or that it could reduce the virus transmission (OR = 7.34, 95%CI [4.22-11.81]) were also significantly more likely to reject the vaccination. Safety concerns were also significant predictive factors (OR = 7.9, 95%CI [4.10-11.27]. Confidence level in the authorities played a significant role in patient's acceptance of the vaccine, indeed patients who are not registered (OR = 5.9, 95%CI [1.58-8.7]) or not informed about the Tunisian national vaccination platform EVAX (OR = 5.51, 95%CI [2.1-7.9]) were more likely to be against the vaccine. CONCLUSION: Cancer patient's education about the impact of the vaccine on their disease and on the COVID-19 is needed. Governments should build strategies to gain more population confidence.

Survival and prognostic factors in adult medulloblastoma: the Salah Azaiz Institute experience.

BACKGROUND: Medulloblastoma is the most common malignant brain tumor in children. This entity in adulthood is rare. The aim of our study is to evaluate therapeutic results and prognostic factors of adult medulloblastoma treated at our institute with post-operative radiotherapy. METHODS: We retrospectively reviewed a cohort of 55 patients with medulloblastoma who underwent radiation in the department of radiation oncology of institute Salah Azaiz (Tunis) over a 18-year period (1994-2012). RESULTS: The surgery was total or subtotal resection in 73% of cases. Forty-eight patients received radiotherapy to the entire craniospinal axis as part of the curative treatment. The median interval from surgery to the initiation of radiotherapy was 83 days. Etoposide-cisplatin chemotherapy was only performed in metastatic patients (n = 4). The 5-years and 10-years overall survival rates were respectively 53 and 34%. The dose of radiotherapy to the craniospinal axis was a prognostic factor. The 5-years and 10-years event-free-survival rates were 64 and 41%. Reduction in the dose of radiotherapy to the craniospinal axis and fourth ventricular floor involvement were correlated with a worse event-free survival. CONCLUSION: Our results, compared to those of the literature, conclude that the reduction in the dose of radiotherapy to the craniospinal axis (<34 Gy) in the standard risk group of adult medulloblastoma could not be done without chemotherapy. In the high-risk group of adult medulloblastoma, radiotherapy to the cerebrospinal axis at the dose of 36 Gy with chemotherapy, is required for disease control.

Once-a-day fractionated total-body irradiation: A regimen tailored to local logistics in allogeneic stem cell transplantation for acute lymphoblastic leukemia.

AIM: The objective of the study was to estimate the cumulative incidence (CI) of relapse, relapse-free survival (RFS) and overall survival (OS) in ALL patients after a once-a-day fractionated TBI (F-TBI) regimen with 9.9 Gy. The secondary objectives were evaluation of short and long-term toxicity and non-relapse mortality (NRM). BACKGROUND: Total body irradiation (TBI), as a part of the conditioning regimen before allogeneic stem cell transplantation (ASCT) for acute lymphoblastic leukemia (ALL), allows disease control by eradicating residual blast cells in the transplant recipient. MATERIALS AND METHODS: Retrospective study conducted in patients with ALL who received between March 2003 and December 2013 a conditioning regimen with F-TBI and chemotherapy. Irradiation was delivered with 3.3 Gy once-a-day for three consecutive days. RESULTS: Eighty-seven patients were included. The median age was 19 years (range: 5-49 years). The 3-year CI of relapse was 30%. The estimated 3-year RFS and OS were 54% and 58%, respectively. Cumulative incidence of acute graft-versus-host disease (aGVHD) grade II-IV and chronic GVHD (cGVHD) was 31% and 40%, respectively. Interstitial pneumonitis was observed in 2 patients. The 3-year CI of NRM was 16%. In multivariate analysis, cGVHD was associated with a lower CI of relapse (RR = 0.26, 95% CI: 0.07-0.95, p = 0.04). High-risk cytogenetics was associated with a lower RFS (RR = 2, 95 CI: 1.04-3.84, p = 0.03). Grade II-IV aGVHD was an independent predictor of higher CI of NRM (RR = 6.7, 95% CI: 1.4-31.7, p = 0.02). CONCLUSIONS: Once-a-day F-TBI regimen is effective, safe and practical in patients who underwent ASCT for ALL.

Correlation between ebv co-infection and HPV16 genome integrity in Tunisian cervical cancer patients.

Infection with high risk Human papillomavirus (HR-HPV) is necessary but not sufficient to cause cervical carcinoma. This study explored whether multiple HR-HPV or coinfection with Epstein-Barr virus (EBV) influence the integration status of HPV16 genome. The presence and typing of HPV in a series of 125 cervical specimens were assessed by polymerase chain reaction (PCR) using the specific primers for the HPV L1 region. As for EBV infection, the viral EBNA1 gene was used for its detection through PCR amplification. Disruption of the HPV E2 gene was assessed by amplification of the entire E2 gene with single set of primers, while E2 transcripts were evaluated by a reverse transcription PCR method (RT-PCR). The overall prevalence of HPVDNA was of 81.8% in cervical cancers versus 26.9% in benign lesions. In HPV positive cases, HPV16 and HPV18 were the most prevalent types, followed by HPV types 33, 31. EBV EBNA1 prevalence was statistically more frequent in cervical carcinomas than in benign lesions (29.5%, vs 9.6%; P=0.01). No viral infection was detected in healthy control women. The uninterrupted E2 gene was correlated with the presence of E2 transcripts originating from the HPV episomal forms. It was observed that integration was more common in HPV18 and EBV coinfection. The presence of EBV caused a five-fold [OR= 5; CI= 1.15-21.8; P = 0.04] increase in the risk of HPV16 genome integration in the host genome. This study indicates that EBV infection is acting as a cofactor for induction of cervical cancer by favoring HPVDNA integration.

[Atypical presentations of internal mammary chain involvement in breast cancer]. / Les aspects trompeurs de l'atteinte de la chaîne mammaire interne dans les cancers du sein.

BACKGROUND: Breast cancer is the first cancer in women. Lymphatic involvement in breast cancer is common, especially in our patients because of the frequency of locally advanced forms. This contrast with a weak rate of diagnosed internal mammary chain invasion. METHODS: We present observations of patients presenting atypical forms of internal mammary chain involvement. AIM: To clarify the atypical presentations of internal mammary chain involvement in breast cancer. RESULTS: The invasion of internal mammary chain is often underestimated. Indeed, this site of lymphatic spread is not accessible to the clinical exam and its radiological exploration is not systematic. Otherwise, different clinical, pathological and radiological presentations have to attract our attention to a potential internal mammary chain invasion. CONCLUSION: Our misrecognition of this site of spread and its different presentations can partly explain the lack of diagnosis.

Concurrent Chemoradiotherapy as an Adjuvant Treatment of Primary Central Nervous System Neuroblastoma.

Primary central nervous system neuroblastoma is a rare malignant embryonal tumor. With only few cases reported in the literature, data on regardingthe diagnosis and management of these tumors are limited. We reported a case of primary cerebral neuroblastoma in a 20-year-old woman complaining of progressive headaches. The patient underwent subtotal tumor resection and adjuvant concurrent chemoradiotherapy. The prescription dose was 54 Gy. She remained free of recurrence for 14 months after the end of radiotherapy treatment.

[Radiation therapy in extra abdominal desmoid tumours]. / Radiothérapie des tumeurs desmoïdes extra abdominales.

BACKGROUND: Desmoid tumours are rare benign tumours that have local "malignity". They can be locally aggressive by infiltrating adjacent vascular, nervous and bony structures. AIM: To define the role of radiotherapy in the management of desmoid tumours. METHODS: Retrospective study of six extra-abdominal desmoid tumours treated with surgery and radiation therapy. RESULTS: Median age was 26.8 years (16-35 years). The tumor was located in the arm (1 case), in the legs (2 cases) and in the body (3 cases). Median tumoral sizes were 86.6 mm (60-100 mm). Five patients had local recurrence after surgical resection. Radiation therapy included Cobalt 60 in five cases and photons associated to linear acceleration in one case. Total dose was between 54 and 62 Gy. At the end of radiation therapy, tumoral control was obtained in five cases after a median follow-up of 26 months (1-83 months). CONCLUSION: Surgery is the main treatment of desmoids tumours but local recurrence rates remain high even after complete resection. The role of adjuvant radiation therapy is controversial.

Management of patients with cardiac implantable electronic devices (CIED) undergoing radiotherapy: A consensus document from the Tunisian Society of Oncology Radiotherapy and the Tunisian Society of Cardiology and Cardiovascular Surgery.

In patients with cardiac implantable electronic devices CIEDs, including cardiac pacemakers (PM) and implantable cardioverter-defibrillators (ICD), radiotherapy (RT) could compromise CIED function. Managing radiotherapy patients with CIED, has been a great practical and procedural challenge in radiotherapy and requires a structured multidisciplinary approach. A consensus document is presented as a result of a multidisciplinary working group involving cardiac electrophysiologists, Radiation Oncologists and Medical physicists. It aims to propose recommendations on risk stratification, management approach before, during and after radiation treatment/course of patients with CIED.

Clear cell carcinoma of the uterus.

AIM: The aim of this study was to determine the characteristics and outcome of patients presenting with clear cell carcinoma (CCC) of the endometrium treated in a single institution. METHODS: We reviewed the records of patients treated in the Salah-Azaiz institute for CCC of the endometrium. A histopathological stage was retrospectively assigned to these patients according to the FIGO classification and was compared to the clinical stage. Pathological features were studied in order to determine predictif factors of extrauterine disease extention and failure patterns. RESULTS: 12 patients were included in the study. The mean age at diagnosis was 64 years (50 to 84 yers). Upstaging after surgery was found in 9 patients. 9 patients had extrauterine extension. Deap myometrial invasion was not correlated with extrauterine extension. After a median follw up of 32 months, 4 patients presented with recurrences: one vaginal recurrence, two cases of pelvic and abdominal recurrence and abdominal recurrence in one patient. All recurrences occurred during the first year after surgery. Tumor recurrence was located within the radiation field in one case. Two patients with abdomino-pelvic recurrences progressed despite the association of surgery, radiation therapy and chemotherapy. CONCLUSION: Extrauterine extension is frequent at diagnosis and not correlated to classical risk factors observed in endometrioid carcinoma. A comptlete surgical staging is necessary for adjuvant treatment. Locoregional and distant recurrences are frequent and have a poor outcome.

[Tumors of the pineal region: retrospective study of 40 cases]. / Les tumeurs de la région pinéale: étude rétrospective à propos de 40 cas.

BACKGROUND: the tumours of the pineal region are rare brain tumours, most common in children and characterized by a large clinical and histologic polymorphism. AIM: to assess the outcome and prognostic factors of 40 patients with primitive pineal region tumours treated at the department of radiotherapy of Salah Azaiz institute. METHODS: between January 1977 and December 2000, 40 patients received radiotherapy. There were 22 adults and 18 children (age < 16 years). The mean age was 20.4 years and sex ratio was 2.07. Histologic diagnosis was confirmed in 11 cases; 16 patients had a CT evaluation after 20 Gy radiotherapy and in 13 cases diagnosis was performed with CT aspects ± germinal tumour markers. Target volume varied; 10 had craniospinal irradiation, 16 had local irradiation and 14 had whole brain irradiation with a boost at the tumour bed. Chemotherapy was proposed for metastases and recurrent diseases. RESULTS: survival rates were 87% at 2 years and 74, 5% at 5 years. For children, survival rates were 88% at 2 and 4 years. Eight patients (20%) failed locally and 5 patients (12.5%) had metastasis. Age, performance status and large fields of radiotherapy seem to be associated with prognosis and survival. CONCLUSION: Pineal tumours and especially germinal tumours are chemosensitive and radiosensitive, care of these tumours is multidisciplinary involving surgery, chemotherapy and radiotherapy. From our study and a review of the literature, we tried to find a therapeutic strategy for tumours of the pineal region.

Cancer care and COVID-19: tailoring recommendations for the African radiation oncology context.

Africa is the second most populous continent after Asia comprising 54 countries. Given the healthcare system deficiencies in Africa, the impact of the COVID-19 pandemic was expected to be disastrous. The first case of COVID-19 on the continent was reported in Egypt on 14 February 2020. By 13 May, cases had been reported in all 54 countries. Several practice guidelines specific to radiation oncology departments have been published, including prioritisation criteria for postponing radiotherapy, continuation of treatment, hypofractionation or even omitting radiotherapy. The oncology community in Africa has suddenly needed to protect both patients and caregivers and to ensure continuity of essential clinical services despite several challenges. Considering equipment unavailability, lack of human resources and poor infrastructure, tailoring COVID-19 pandemic management to the African context seems mandatory and a unified approach to guideline development in this context is encouraged. In this article, we discuss contextual issues coming into play, highlighting steps to be taken by radiotherapy centres in Africa to mitigate fallouts from the current pandemic to ensure the safety of our patients and staff as well as the impact on future care.

Synergistic Effect and Tolerance of Concurrent Radiotherapy and Lenalidomide Use in Relapsing Mantle Cell Lymphoma: A Case Report.

INTRODUCTION: Mantle cell lymphoma is an aggressive disease. Limited treatment options are available for refractory or relapsing presentation. We report the first case, to the best of our knowledge, of concurrent radiotherapy and lenalidomide use in this setting, focusing on its possible synergy and tolerance. CASE PRESENTATION: A 76-year-old man with a history of mantle cell lymphoma presented with ptosis of the left eyelid, eyelid swelling, and nasal obstruction. Results of positron emission tomography-computed tomography revealed a pathologic fluorodeoxyglucose uptake at the pharynx and left eyelid. He received treatment with ibrutinib, which was stopped 3 months later because of digestive toxic effects. Radiotherapy for the eyelid and pharynx was performed at a dose of 18 Gy, with concurrent lenalidomide administration. Evaluation 3 months later revealed complete disappearance of the 2 relapse sites. DISCUSSION: This case highlights the role of concomitant lenalidomide treatment and low-dose radiotherapy in patients with relapsing mantle cell lymphoma. Use of this combination treatment has achieved a complete local control with a safe toxicity profile. The case also illustrates the possible lenalidomide-induced radio sensitization.

[Prognostic value of parapharyngeal extension in nasopharyngeal carcinoma]. / Valeur pronostique de l'extension parapharyngéee dans les carcinomes nasopharyngés.

AIM: This study evaluated the prognostic value of the Para pharyngeal space involvement in nasopharyngeal carcinoma T 2 disease (UICC 1997 classification). METHODS: From January 1997 and December2001; 32 patients with nasopharyngeal carcinoma were examined by CT scan and according to the 1997 International Union Against Cancer (UICC) staging system, 15 had stage T2a M0 (G1) and 17 T2bM0(G2). The median age was 47 years. The male to female ratio was 1.81 (G1); 4.3 (G2). All patients were pathologically confirmed by biopsy from the nasopharynx as having UCNT in 100% (G1) and 94% (G2). The node involvement was 52% for the G1 (N2: 26%, N3: 26%) and 80% for the G2 (N2: 47%, N3: 41%). Both neoadjuvant chemotherapy and radiotherapy were performed for advanced N disease and only radiotherapy for NO. RESULTS: Examination and CT scan were performed for the evaluation of the treatement. The completely clinical remission after chemotherapy was 12.5% (G1) and 53% (G2), partial remission was 25% (G1) and 35% (G2). The CT scan control wasn't performed for all patients. The complete response was 69% (G1) and 53% (G2); partial response was 6% for both two groups. The median follow up was 79 months. Disease free survival rates were 70% for G1 (T2a) and 48% for G2 (T2b). Distant metastasis rates were 26% (G1) vs 6% (G2) and more likely in the presence of advanced N disease. Five years overall survival was 78% (G1) T2a vs. 55% (G2) T2b.The N disease was correlated to metastasis as overall survival was 66.7% for N3 disease vs 85.7% for N0. CONCLUSION: Parapharyngeal tumor involvement affects local and regional tumor failure. Subclassification of T2 disease into T2a/T2b should have an impact on treatment strategies.

[Internal mammary lymph node invasion in breast cancer: myth or reality?]. / L'atteinte de la chaîne mammaire interne dans le cancer du sein: mythe ou réalite?

The internal mammary nodes are often underestimated as breast cancer lymphatic pathway spread. It is yet the first site of lymphatic invasion in central or internal tumors and the second site in external tumors. The intra-thoracic situation of internal mammary nodes explains partly, the difficulty of its exploration. To evaluate the risk of internal mammary node invasion, some predictive factors are established (tumor size, internal or central tumor location, axillary node invasion and young age). Prognostic and therapeutic impact of invasion justifies its systematic research. Without exploring internal mammary nodes status, TNM classification remains, incomplete. CT scanner, magnetic resonnance imaging, positron emission tomography scanner and sentinel node exploration technique are helpful to explore this region and to adapt its irradiation.

HPV16 E2 variants correlated with radiotherapy treatment and biological significance in cervical cell carcinoma.

Specific genetic mutations in human papillomavirus type 16 (HPV16) DNA are considered important in cervical lesion progression. This study analyzes to what extent radiotherapy treatment contributes to viral DNA mutation in cervical cell carcinomas, and the biological significance of these mutations. Serial tumor tissue, including 44 cervical cancer samples, collected before and after radiotherapy, and 52 biopsies with benign cervices, were tested and analyzed for the presence of HPV16, and for the integrity of the E2 gene. Analysis was performed with polymerase chain reaction (PCR), and a bidirectional sequencing assay was performed to find HPV16 E2 gene variants. HPV16 E2 accounted for 81.8% and 37.5% among tumor and benign cervices respectively (p = 0.02). The incremental number of DNA mutations was associated with radiotherapy treatment. Most E2 gene mutations involved regions encoding the amino-terminal and carboxy-terminal regions of E2 in the tumor irradiated samples. Amino acid changes T135 K, A143T, N203D and P208A in the amino-terminal region were the most common mutations across the irradiated samples. Rather, the mutations in the carboxy-terminal region (T3694A and T3805G) were synonymous changes. Specific nucleotide deletions were detected in the hinge domain, at positions 3455A > -, 3466 T > -, and 3501A > -. The mutation degree is influenced by the irradiation modalities, interestingly E2 sequence mutation being found widely after radiotherapy treatment with a total fractioned dose of 50 Gy (p = 0.004). E2 mutation has predictive and biological significance in cervical cancer patients receiving curative radiation therapy. Possibly, E2 mutation could influence viral genome intactness and could serve as an intrinsic marker for cervical cancer.

Radiotherapy utilization in developing countries: An IAEA study.

BACKGROUND: The planning of national radiotherapy (RT) services requires a thorough knowledge of the country's cancer epidemiology profile, the radiotherapy utilization (RTU) rates and a future projection of these data. Previous studies have established RTU rates in high-income countries. METHODS: Optimal RTU (oRTU) rates were determined for nine middle-income countries, following the epidemiological evidence-based method. The actual RTU (aRTU) rates were calculated dividing the total number of new notifiable cancer patients treated with radiotherapy in 2012 by the total number of cancer patients diagnosed in the same year in each country. An analysis of the characteristics of patients and treatments in a series of 300 consecutive radiotherapy patients shed light on the particular patient and treatments profile in the participating countries. RESULTS: The median oRTU rate for the group of nine countries was 52% (47-56%). The median aRTU rate for the nine countries was 28% (9-46%). These results show that the real proportion of cancer patients receiving RT is lower than the optimal RTU with a rate difference between 10-42.7%. The median percent-unmet need was 47% (18-82.3%). CONCLUSIONS: The optimal RTU rate in middle-income countries did not differ significantly from that previously found in high-income countries. The actual RTU rates were consistently lower than the optimal, in particular in countries with limited resources and a large population.

Effect of once-a-day fractionated total body irradiation on the risk of relapse after non-T-cell-depleted HLA-matched sibling transplantation.

PURPOSE: The aim of this study was to assess the impact of fractionated total body irradiation (F-TBI) on treatment-related mortality (TRM) and relapse in patients who received a non-T-cell-depleted allogeneic stem cell transplantation (ASCT) for hematological malignancies. MATERIALS AND METHODS: Between March 2003 and December 2004, a total of 24 patients with HLA-identical sibling donors entered this study and received three doses of 3.33 Gy F-TBI separated by 24 h and cyclophosphamide or etoposide. RESULTS: At a median follow-up of 37 months (range 29-47 months), 4 of the 24 patients (16.6%) died of TRM. Relapse occurred in 10 patients at a median of 9 months (range 2-18 months). Overall, 13 of 24 patients (54%) died. Relapse was the most common cause of death (9/13). The 2-year actuarial survival rate was 46% (+/-11%). CONCLUSION: In our experience, ASCT conditioned with F-TBI was associated with low TRM but a high early relapse rate in patients with hematological malignancies.