Cranial computed tomography in children with acute lymphoblastic leukemia after prophylactic treatment with cranial radiation therapy and intrathecal methotrexate

Abstract

Background and Methods. Thirty‐one children with acute lymphoblastic leukemia (ALL) who had received cranial radiation therapy (Cr RT) and five concomitant doses of intrathecal methotrexate (IT MTX) for central nervous system prophylaxis (CNSP) and who had an event‐free survival exceeding 5 years had cranial computed tomography (Cr CT) examination. The fractional dose for 21 of them was 1.5 Gy. The interval between the completion of CNSP and the time of Cr CT ranged from 5 to 8.5 years, with a median of 5 years 2 months. Results. Unlike the previous reports in the literature that 9–77% of children with ALL who had received Cr RT 18 Gy and IT MTX as CNSP had CT scan abnormalities, in this study no patient had CT scan abnormalities. Conclusions. Our results might be attributable to the fractional dose of Cr RT being adequate, the IT chemotherapy being suitable, and the systemic chemotherapy not being intensive.

Overall and Event-Free Survivals for Acute Lymphoblastic Leukemia in Children at a Single Institution in Taiwan

“…Dexamethasone, a major cyclic component during the maintenance phase, has also made an important contribution to the prevention of CNS relapse, as has been addressed in the Children's Cancer Group [10] and Dutch Childhood Leukemia Study Group [11]. We have previously reported that no patients with such CNS prophylaxis had cranial computed tomography abnormalities [12], and their IQ scores all fell within the average range during a 5-year follow-up [13]. However, longer follow-up is mandatory.…”