המידע באדיבות מדיקונטקסט
Last Updated: 2001-07-25 17:16:23 EDT (Reuters Health)
By Anthony J. Brown, MD
WESTPORT, CT (Reuters Health) – While the use of cranial radiation therapy (CRT) in children with acute lymphoblastic leukemia (ALL) is a controversial topic, it appears that an 18-Gray dose of CRT is effective in preventing central nervous system disease recurrence and it is associated with minimal late neurotoxic effects.
In a 7-year followup study reported in the July 1st issue of Cancer, Dr. Deborah P. Waber from The Children's Hospital in Boston and colleagues assessed the outcomes of 201 children with high-risk ALL who were treated with a regimen that included 18 Grays of CRT.
The mean 5-year overall and event-free survival rates were 82% and 75%, respectively, the authors note. Only two children developed a central nervous system recurrence. Neuropsychologic testing of 61 patients revealed age-appropriate IQ and memory scores, but reduced performance on complex figure drawing tasks. Children who underwent treatment prior to 36 months of age had average IQs, but showed verbal deficits.
"Through the years, CRT protocols have been developed that are less neurotoxic but the concern has been that the efficacy might be compromised," Dr. Waber told Reuters Health. "In the literature, the late effects studies have never really been connected to the efficacy studies. I think [ours] is really the first to look at both the risk and the benefit of CRT," she said.
"The long-term survival rate reported in our paper is excellent and the IQs of these children were normal," Dr. Waber noted. Although the children did show some impairments in other cognitive measures, these effects were small compared to the severely lowered IQs that used to be seen when higher CRT doses were used, she said.
"Our data suggest that children who received CRT at a young age were somewhat more impaired than children who received it at an older age," Dr. Waber pointed out. "We saw one or two patients who were treated as infants and they were pretty impaired," she said. "We should be more careful when treating younger patients, but we shouldn't withhold treatment from an older child based on the findings with younger patients."
Dr. Waber said that her institution is currently assessing the safety and efficacy of CRT with doses lower than 18 Grays.
Cancer 2001;92:15-22.
-Westport Newsroom 203 319 2700
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