Liver-Sparing Total Body Irradiation Using Helical Tomotherapy for Relapsed Pre-B-cell Acute Lymphoblastic Leukemia.

Liver toxicity is an uncommon but reported complication of total body irradiation (TBI). The risk of this complication may be magnified in patients with previous hepatic parenchymal disease. In this context, to the best of our knowledge, we present the first case of liver-sparing TBI using helical tomotherapy in a patient with pre-existing liver disease. In this case, we discuss a 23-year-old male with relapsed precursor B-cell acute lymphoblastic leukemia (pre-B-ALL) who received myeloablative TBI. Tomotherapy allowed us to treat the entire body to 12 Gy in eight fractions, while achieving a mean liver dose of 5.98 Gy, meeting the targeted liver constraint of a mean dose less than 9 Gy. This case demonstrates the feasibility of liver-sparing TBI.