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Cranial Irradiation in Pediatric Leukemia Unnecessary

Last Updated: June 24, 2009.

 

Intensified systemic and intrathecal chemotherapy reduces risk of central nervous system relapse

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In children newly diagnosed with acute lymphoblastic leukemia, effective risk-adjusted chemotherapy may eliminate the need for prophylactic cranial irradiation, according to a study published in the June 25 issue of the New England Journal of Medicine.

WEDNESDAY, June 24 (HealthDay News) -- In children newly diagnosed with acute lymphoblastic leukemia, effective risk-adjusted chemotherapy may eliminate the need for prophylactic cranial irradiation, according to a study published in the June 25 issue of the New England Journal of Medicine.

Ching-Hon Pui, M.D., of St. Jude Children's Research Hospital in Memphis, Tenn., and colleagues studied outcomes in a total of 498 patients, including 71 patients who previously would have received prophylactic cranial irradiation and 56 historical controls who did receive it.

Overall, the researchers found high rates of five-year event-free and overall survival (85.6 and 93.5 percent, respectively) and observed low five-year risks of isolated or any central nervous system relapse (2.7 and 3.9 percent, respectively). Compared to the 56 historical controls, they also found that the 71 patients who did not receive prophylactic cranial irradiation had significantly longer continuous complete remission.

"Our study showed that with intensification of systemic and intrathecal chemotherapy, prophylactic cranial irradiation can be totally omitted without compromising overall survival," the authors conclude.

Several authors reported relationships with the pharmaceutical and medical industry.

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