Radiotherapy for Leukemia: Past, Present and Future

The use of radiotherapy (RT) in the management of leukemia has evolved. Historically, RT was critical for disease control in sanctuary sites, such as the central nervous system (CNS) and testes. However, modern chemotherapy is highly effective, even within sanctuary sites, so RT utilization has declined substantially. Nonetheless, RT maintains some important roles. For example, in young patients with acute lymphoblastic leukemia undergoing stem cell transplantation (SCT), a total body irradiation (TBI)-based preparative regimen has been associated with improved survival, when compared to myeloablative chemotherapy regimens. Historically, TBI was delivered using static, parallel opposed photon beams (2D-TBI); however, recently, centers have increasingly used intensity modulated radiation therapy (IMRT) techniques. Relative to 2D-TBI, IMRT can reduce doses to critical organs while delivering myeloablative doses to the rest of the body, so it may decrease the risk of toxicity while maintaining oncologic outcomes. Multi-organ-sparing, dose-escalated total marrow irradiation (TMI) and total marrow/lymphoid irradiation (TMLI) are related concepts that aim to reduce toxicity and increase efficacy in patients without standard SCT options, including those with persistent, chemorefractory disease. IMRT-based TBI, as well as TMI/TMLI, may continue to expand and redefine how RT is used as a part of leukemia therapy.

Topics:

  1. Indications for Radiation Therapy in Leukemia: A Shifting Landscape
    Susan Y. Wu, MD
  2. Modern Radiation Therapy as a Component of Stem Cell Transplantation: Clinical Perspectives
    Susan M. Hiniker, MD
  3. Modern Radiation Therapy as a Component of Stem Cell Transplantation: Technical Considerations 
    Nataliya Kovalchuk, PhD, DABR, FAAMP
  4. Total Marrow Irradiation (TMI): Redefining and Expanding the Role of Radiation Therapy Conditioning in Hematopoietic Cell Transplantation
    Jeffrey Y.C. Wong, MD, FASTRO
  5. Q and A
    Sarah Milgrom, MD – Moderator
    Full Panel

This activity is available from March 24, 2026, through 11:59 p.m. Eastern time on September 23, 2028. 

The content was originally presented and recorded at the 2025 ASTRO Annual Meeting.

Target Audience

The activity is designed to meet the interests of medical oncologists, radiation oncologists, physicists, radiation therapists, radiation dosimetrists and residents.

Learning Objectives

Upon completion of this activity, participants should be able to:

  • Explain how and why indications for radiotherapy in leukemias have changed with time. 
  • Describe the potential advantages, as well as the challenges, of delivering total body irradiation using conformal techniques.
  • Discuss potential future applications of radiotherapy in the management of leukemia, including total marrow irradiation and total marrow/lymphoid irradiation. 
Course summary
Available credit: 
  • 1.25 AMA PRA Category 1 Credit™

    The American Society for Radiation Oncology (ASTRO) is accredited by the Accreditation Council for Continuing Medical Education for physicians. ASTRO designates this Enduring material for a maximum of 1.25 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

  • 1.25 Certificate of Attendance
    This activity was designated for 1.25 AMA PRA Category 1 Credit™.
Course opens: 
03/24/2026
Course expires: 
03/23/2028
Cost:
$149.00
Rating: 
0

  Moderators: 

  • Sarah A. Milgrom, MD, is employed by University of Colorado. Dr. Milgrom served in an uncompensated role as a consultant with Bristol Myers Squibb. 
  • Colton John Ladbury, MD, is employed by City of Hope National Medical Center. Dr. Ladbury receives grant/research funding from RefleXion Medical. 

Speakers:

  • Susan Y. Wu, MD, is employed by The University of Texas MD Anderson Cancer Center and Howard Hughes Medical Institute. Dr. Wu receives grant/research funding from Kite Pharma and SIRPant Immunotherapeutics, Inc. 
  • Susan M. Hiniker, MD, is employed by Stanford University School of Medicine. Dr. Hiniker has no relevant financial relationship with ineligible companies to disclose. 
  • Nataliya Kovalchuk, PhD, DABR, FAAMP, is employed by Stanford University. Dr. Kovalchuk has no relevant financial relationship with ineligible companies to disclose.
  • Jeffrey Y.C. Wong, MD, FASTRO, is employed by City of Hope National Medical Center. Dr. Wong receives grant/research funding from Accuray, Inc., Blue Earth Diagnostic, Fusion, Inc., Imaginab, Janssen, Varian, Reflexion and Novartis. Dr. Wong receives compensation/payment from Telix, Inc.    

Planners:

  • Malcolm Mattes, MD is employed at Rutgers Cancer Institute. Dr. Mattes received research/grant funding from Gilead Sciences (relationship ended 8/30/2025). Dr. Mattes has no relevant financial relationship with ineligible companies. 
  • Parul Barry, MD, is employed by the University of Pittsburgh Medical Center. Dr. Barry has no relevant financial relationship with ineligible companies. 
  • Michael Haddock, MD, is employed by Mayo Clinic and has no relevant financial relationship with ineligible companies to disclose.
  • Manisha Palta, MD, is employed by Duke Cancer Center and Duke University Hospital. Dr. Palta receives grant/research funding from Merck and Varian Medical Systems. 
  • Salma Jabbour, MD, is employed by Rutgers Cancer Institute. Dr. Jabbour receives grant/research funding from Merck & Co., Inc. and Beigene. Dr. Jabbour receives compensation/payment as a consultant with Radialogica and IMX Medical. 

All relevant financial relationships have been mitigated.

The American Society for Radiation Oncology (ASTRO) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Available Credit

  • 1.25 AMA PRA Category 1 Credit™

    The American Society for Radiation Oncology (ASTRO) is accredited by the Accreditation Council for Continuing Medical Education for physicians. ASTRO designates this Enduring material for a maximum of 1.25 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

  • 1.25 Certificate of Attendance
    This activity was designated for 1.25 AMA PRA Category 1 Credit™.

Price

Cost:
$149.00
Please login or register to take this course.

Course Fees:
ASTRO members must log in to the ASTRO website to view and receive the member rate.

  • Nonmember: $149
  • Member: $99
  • Member-in-Training: $49
  • Student/Graduate Student/PGY-1 Member: $49
  • Postdoctoral Fellow Member: $49

If you are an ASTRO member from a low or lower-middle income country, as identified by the World Bank, you can receive a 50% discount off your corresponding registration for this activity. Please email [email protected] to inquire about the discount.

Policies:
No refunds, extensions, or substitutions will be made for those participants who, for any reason, have not completed the activity by the expiration date. 

Participants using ASTRO Academy activities to satisfy the requirement of a Continuing Certification (MOC) program should verify the credit number and type and availability dates of any activity before making a purchase. No refunds, extensions, or substitutions will be made for participants who have purchased activities that do not align with their MOC requirement.

The activity and its materials will only be available on the ASTRO website until March 23, 2028, regardless of purchase date. At the expiration of the activity, participants will no longer have access to the activity or its materials. ASTRO reserves the right to remove an activity before its expiration date. 

Required Hardware/software

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