Outcomes of a randomized trial of hyperfractionated cranial radiation therapy for treatment of high-risk acute lymphoblastic leukemia: therapeutic efficacy and neurotoxicity

Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology
D P WaberS E Sallan

Abstract

We evaluated 8-year survival and late neuropsychologic toxicity in children with acute lymphoblastic leukemia treated in a randomized clinical trial to test whether hyperfractionated (twice daily) cranial radiation therapy (CRT) can reduce incidence and severity of late toxicities associated with 18 Gy of CRT. Between 1987 and 1995, 369 children treated on two consecutive Dana-Farber Cancer Institute Consortium protocols for high-risk acute lymphoblastic leukemia were randomly assigned to conventionally fractionated CRT (CFX) or hyperfractionated CRT (HFX) to a total dose of 18 Gy. Neuropsychologic testing was completed for 125 of 287 children in continuous complete remission. Event-free and overall survival, as well as neuropsychologic function, were compared for the two arms of the protocol. Eight-year event-free survival (+/- SE) was 80% +/- 3% for children randomly assigned to CFX and 72% +/- 3% for HFX (P =.06). Overall survival was 85% +/- 3% for CFX and 78% +/- 3% for HFX (P =.06). CNS relapses occurred in 2.8% of patients receiving CFX and 2.7% receiving HFX (P =.99). Cognitive function for both groups was solidly in the average range, with no group differences in intelligence, academic achievement, visuospatial reasoni...Continue Reading

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Citations

Oct 18, 2006·Child's Nervous System : ChNS : Official Journal of the International Society for Pediatric Neurosurgery·Necmettin TanrioverMustafa Uzan
Mar 21, 2009·Child's Nervous System : ChNS : Official Journal of the International Society for Pediatric Neurosurgery·Ewa BienAnna Balcerska
Aug 4, 2009·Journal of Pediatric Hematology/oncology·Manuel DieziMaja Beck-Popovic
Jun 8, 2011·Journal of Pediatric Hematology/oncology·Kim EdelsteinBrenda J Spiegler
Mar 1, 2008·The Lancet Oncology·Ching-Hon Pui, Scott C Howard
Oct 17, 2008·Developmental Disabilities Research Reviews·Laura A Janzen, Brenda J Spiegler
Aug 29, 2006·European Journal of Cancer : Official Journal for European Organization for Research and Treatment of Cancer (EORTC) [and] European Association for Cancer Research (EACR)·Nathalie C JansenWillem A Kamps
Apr 22, 2016·Pediatric Blood & Cancer·Andrea TangStacey Marjerrison
Jan 1, 2013·Epilepsy & Behavior Case Reports·Yun LengWenming Chen
Nov 11, 2006·Pediatric Blood & Cancer·Kathryn VannattaRobert B Noll
Jun 4, 2011·Pediatric Blood & Cancer·Deborah P Waber
Jan 28, 2005·Journal of Neuro-oncology·Joachim M Baehring
Apr 4, 2021·International Journal of Radiation Oncology, Biology, Physics·Anita MahajanMichele Avanzo

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