Effect of different doses of prophylactic cranial irradiation in childhood lymphoblastic leukemia on CNS relapse, late cognitive decline and learning disabilities

Meshref, Mohamed; El-Shazly, N.; Nasr, Mohamed; Abdelhai, Rehab

doi:10.7243/2049-7962-2-10

Cited by 4 publications

(3 citation statements)

References 19 publications

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“…De-intensification of cancer treatment in children and young adults has gathered considerable momentumas the long-term childhood cancer survivors are at an increased risk of serious health related issuesrelatedto treatment [1,2]. Since radiation is one of the major contributors to the late effects in children including growth defects, neuro-cognitive defects, endocrinopathies, cardiovascular effects, lymphedema and secondary malignant neoplasms (SMN) [3], there has been a widespread evaluation of radiation de-intensification in the last two decades for several haematological and solid tumors [4,5,6]. Radiation therapy however cannot be completely avoided in many clinical protocols and remain an integral component of management and the best possible conformal techniques of radiation should be employed in such situations.…”

Section: Demographic Profile and Early Clinical Experience Of Treating Children And Young Adults With Image Guided Proton Beam Therapy Inmentioning

confidence: 99%

Demographic profile and early clinical experience of treating children and young adults with image guided proton beam therapy in India

Chilukuri

Burela

UPPULURI

et al. 2020

Preprint

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Background: We report demographic profile and our initial experience of treating children and young adults with image guided pencil beam scanning proton beam therapy (PBS-PBT) at our centre. Material and methods: All patients younger than 25 years, consecutively treated with PBT based on a multi-disciplinary tumor board decision were analyzed. Patients were treated under daily on-board kilovoltage x-ray and/or cone beam CT scan guidance. The demographic profile, treatment characteristics and the acute toxicities were reported. Patient and treatment related factors and their association with acute toxicities were analyzed using univariate and multivariate analysis. Results: Forty-seven patients {27 with central nervous system(CNS) and 20 with non-CNS tumors} with a median age of 9 years were evaluated. Most common diagnoses were ependymoma, rhabdomyosarcoma and glioma. Median dose delivered was 54.8CGE(40-70.4) to a median clinical target volume of 175cc (18.7-3083cc) with 34% requiring concurrent chemotherapy(CCT). Acute grade-2 and 3 dermatitis, mucositis, and hematological toxicity was noted in 45% and 2%; 34% and 0%; 38% and 30%; respectively. Grade-2 fatigue was noted in 26%. On univariate analysis, CCT(p=0.009) and cranio-spinal irradiation(p<0.001) were associated with grade-2 or more hematological toxicity in patients with CNS tumors. Among non-CNS tumors, clinical target volume more than 150cc was associated with grade-2 or more fatigue(p=0.017). Conclusions: The demographic pattern of patients treated with PBT at this new and only centre in the region was similar to previously published literature. Image guided PBS-PBT resulted in acceptable acute toxicities both among children with CNS and non-CNS tumors.

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Section: Demographic Profile and Early Clinical Experience Of Treating Children And Young Adults With Image Guided Proton Beam Therapy Inmentioning

confidence: 99%

Demographic profile and early clinical experience of treating children and young adults with image guided proton beam therapy in India

Chilukuri

Burela

UPPULURI

et al. 2020

Preprint

View full text Add to dashboard Cite

show abstract

“…1,2 Because radiation is one of the major contributors to late effects in children (including growth defects, neurocognitive defects, endocrinopathies, cardiovascular effects, lymphedema, and secondary malignant neoplasms), 3 there has been a widespread evaluation of radiation de-intensification in the last two decades for several hematologic and solid tumors. [4][5][6] Radiation therapy, however, cannot be completely avoided in many clinical protocols and remains an integral component of management; the best possible conformal techniques of radiation should be used in such situations. 7 Proton beam therapy (PBT), because of its superior physical properties, results in significantly lower doses of radiation to healthy normal structures.…”

Section: Introductionmentioning

confidence: 99%

Preliminary Experience of Treating Children and Young Adults With Image-Guided Proton Beam Therapy in India

Chilukuri

Burela

Uppuluri

et al. 2020

JCO Global Oncology

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PURPOSE Proton beam therapy (PBT) has been a preferred modality in pediatric malignancies requiring radiotherapy. We report our preliminary experience of treating consecutive patients younger than 25 years with image-guided pencil beam scanning PBT from the first and only center on the Indian subcontinent. METHODS Patients were selected for PBT on the basis of a multidisciplinary tumor board decision. Patient demographic data, as well as tumor and treatment-related characteristics of the cohort, were captured. Patient and treatment-related factors and their association with acute toxicities were analyzed using univariable and multivariable analyses. RESULTS Forty-seven patients (27 with CNS and 20 with non-CNS tumors) with a median age of 9 years (range, 2-25 years) were evaluated. Most common diagnoses were ependymoma, rhabdomyosarcoma, and glioma. Seventy-seven percent of patients traveled more than 500 km, and 70% of them lived in metropolitan cities. Forty-nine percent of patients had recurrent disease at presentation, and 15% had received a previous course of radiation. The median dose delivered was 54.8 cobalt gray equivalents (range, 40.0-70.4 cobalt gray equivalents) to a median clinical target volume of 175 mL (range, 18.7-3,083.0 mL), with 34% of patients requiring concurrent chemotherapy (CCT). Acute grade 2 and grade 3 dermatitis, mucositis, and hematologic toxicity was noted in 45% and 2%, 34% and 0%, and 38% and 30% of patients, respectively. Grade 2 fatigue was noted in 26% of patients. On multivariable analysis, for CNS tumors, both CCT and craniospinal irradiation were independently associated with ≥ 2 grade hematologic toxicity, whereas among non-CNS tumors, a clinical target volume > 150 mL was associated with ≥ 2 grade fatigue, head and neck irradiation was associated with ≥ 2 grade mucositis, and CCT was associated with grade ≥ 2 hematologic toxicity. CONCLUSION This study demonstrates safe implementation of a PBT program for children and young adults on the Indian subcontinent. Image-guided pencil beam scanning PBT in judiciously selected patients is feasible and can be delivered with acceptable acute toxicities.

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“…The relationship between the use of CRT and the emergence of late neurocognitive deficits suggests that patients who receive radiation are at the highest risk for long-term impairment among all patients (e.g. Jankovic et al, 1994;Meshref, ElShazly, Nasr, & AbdElhai, 2013). Radiation-related impairments may emerge soon after treatment, or they may take time to develop.…”

Section: Cranial Radiation Therapymentioning

confidence: 99%

A multi-method study of neuropsychological functioning following treatment for pediatric acute lymphoblastic leukemia (ALL)

Schwarz¹

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Cancer treatment, such as intrathecal chemotherapy and cranial radiation therapy, are frequently cited for their negative influence on neuropsychological functioning. Deficits have been noted in areas such as working memory, attention, IQ, and learning. The research reported herein used a multi-modal approach to explore the predictive value of inter-individual and treatment-related risk factors. In Study 1, I used a cross-sectional design to compare children treated for acute lymphoblastic leukemia (ALL) with a healthy control group for the association between predictive risk factors and deficits in verbal learning and memory, and IQ. In Study 2a, I analysed a longitudinal sample of individuals treated for pediatric ALL to explore changes in neuropsychological abilities over time, and evaluated their association with predictive risk factors. Finally, in Study 2b, I used the longitudinal sample from Study 2a to explore event-related potential components over time as a psychophysiological index of information processing, and the predictive risk factors associated with change over time. Treatment-related factors, such as chemotherapy protocol and total glucocorticoid dose emerged as significant predictors of impairment. The effects of radiation were more subtle than predicted. Sex, age at diagnosis, and indicators of parental well-being also predicted neurocognitive outcomes.This project filled a gap in the existing literature by answering specific questions about the nature of neuropsychological deficits following treatment for pediatric ALL, as well as helping to identify patients most at-risk for these impairments. To my knowledge, this is the first study to explore event-related potentials longitudinally in a pediatric cancer sample, and this technique may prove useful for tracking functional changes in neurocognitive function over time. The deleterious effects of treatment-related toxicity

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Effect of different doses of prophylactic cranial irradiation in childhood lymphoblastic leukemia on CNS relapse, late cognitive decline and learning disabilities

Cited by 4 publications

References 19 publications

Demographic profile and early clinical experience of treating children and young adults with image guided proton beam therapy in India

Demographic profile and early clinical experience of treating children and young adults with image guided proton beam therapy in India

Preliminary Experience of Treating Children and Young Adults With Image-Guided Proton Beam Therapy in India

A multi-method study of neuropsychological functioning following treatment for pediatric acute lymphoblastic leukemia (ALL)

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