Intermediate-dose methotrexate versus cranial irradiation in childhood acute lymphoblastic leukemia: A ten-year follow-up

Freeman, Arnold I.; Boyett, James M.; Glicksman, Arvin S.; Brecher, Martin L.; Leventhal, Brigid G.; Sinks, Lucius F.; Holland, James F.

doi:10.1002/(sici)1096-911x(199702)28:2<98::aid-mpo3>3.0.co;2-n

Cited by 34 publications

(14 citation statements)

References 41 publications

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“…[21][22][23] In successive protocols conducted at St Jude, the cumulative dose of high-dose methotrexate has increased; the greater dose intensity conceivably contributes to the better outcome. Although the cumulative dose of high-dose methotrexate used during the Total X study (15 g/m 2 ) was higher than that used in Total XI or XII (4 and 7.5 g/m 2 , respectively), each individual dose (1 g/m 2 ) was lower than that used during later studies (2 g/m 2 or more) and was followed by higher and more frequent Overt testicular disease of ALL N Hijiya et al doses of leucovorin than those used during later studies, 8 which may have caused the undesirable rescue of leukemic cells.…”

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confidence: 99%

Overt testicular disease at diagnosis of childhood acute lymphoblastic leukemia: lack of therapeutic role of local irradiation

Hijiya

et al. 2005

Leukemia

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To assess the prognosis of overt testicular disease at diagnosis of acute lymphoblastic leukemia, and any therapeutic role of irradiation for this involvement, we reviewed the data of 811 boys treated on St Jude studies Total X-XI (early period) and Total XII-XIV (recent period). In all, 19 boys (2.3%) had testicular disease at diagnosis. In the early period, patients with testicular leukemia had a poorer overall survival (OS) (P ¼ 0.003), eventfree survival (EFS) (P ¼ 0.064), and higher cumulative incidence of relapse (P ¼ 0.041) than did other patients. During the recent period, patients with and without overt testicular leukemia did not differ in OS (P ¼ 0.257), EFS (P ¼ 0.102), or cumulative incidence of relapse (P ¼ 0.51). In a multivariate analysis, OS was lower for patients with testicular disease than for those without the involvement in the early period (P ¼ 0.047) but not in the recent one (P ¼ 0.75). Both patients who received irradiation for residual testicular disease at the end of induction subsequently died of leukemia. Of the other 17 patients who did not receive irradiation, only one developed testicular relapse in combination with bone marrow relapse. In conclusion, the prognostic impact of overt testicular disease has diminished. Irradiation appears to provide no survival advantage to this patient population.

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confidence: 99%

Overt testicular disease at diagnosis of childhood acute lymphoblastic leukemia: lack of therapeutic role of local irradiation

Hijiya

et al. 2005

Leukemia

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“…The combination of intrathecal methotrexate and high-dose intravenous methotrexate in selected populations now results in low CNS relapse rates (4%). Continuous complete remission survival is the same as for patients treated with prophylactic radiotherapy, mainly because isolated CNS relapses can be effectively treated [9]. Late recurrences in the CSF should be recognized and treated early, because they are potentially curable.…”

Section: Incidencementioning

confidence: 99%

Leptomeningeal metastases

Demopoulos

2004

Curr Neurol Neurosci Rep

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Leptomeningeal metastasis, also known as neoplastic meningitis, carcinomatous meningitis, and meningeal carcinomatosis, occurs when cancer cells gain access to cerebrospinal fluid pathways, travel to multiple sites within the central nervous system, settle, and grow. This disease has become an increasingly important late complication in oncology as patients survive longer, develop more brain metastases, and newer chemotherapies fail to penetrate the blood-brain barrier. The hallmark of clinical presentation is a cancer patient who complains of focal neurologic dysfunction and is found to have multifocal signs on neurologic examination. The clinical course is relentlessly progressive; treatment is limited and cures are the subject of case reports. This article reviews the clinical course of leptomeningeal metastasis and addresses recent developments in its pathophysiology, diagnosis, and treatment.

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“…All had previously been randomized to receive either 2400 cGy and intrathecal methotrexate, or intermediate dose systemic methotrexate with intrathecal methotrexate. A 12-year follow-up of these patients suggested that both treatments were associated with similar outcomes in terms of survival [81]. Of 202 survivors who were eligible for the study, 60% were located and 94% of these agreed to take part.…”

Section: Cns Irradiation Vs No High Dose Methotrexatementioning

confidence: 99%

Learning difficulties in children treated for acute lymphoblastic leukaemia (ALL)

Eiser¹,

Tillmann

2001

Pediatric Rehabilitation

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Concern about the adverse affects of brain irradiation used in treatment for childhood leukaemia on children's learning have been put forward since the 1960s. Early work based on assessment of IQ suggested considerable problems associated with CNS irradiation of 2400cGy, and that children who were younger on diagnosis (below 5 years) were particularly at risk. Consequently, new protocols were introduced in which the amount of irradiation was reduced, or children were treated by chemotherapy alone. There is some evidence that reduction from 2400 to 1800cGy irradiation is beneficial, especially for younger children, as is treatment by chemotherapy alone. Methodological problems in conducting this work and limitations in relying on IQ tests are discussed. Where there are no indications of differences in survival, there would seem to be implications for reducing as far as possible the use of CNS directed therapy among young children treated for leukaemia.

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Intermediate-dose methotrexate versus cranial irradiation in childhood acute lymphoblastic leukemia: A ten-year follow-up

Cited by 34 publications

References 41 publications

Overt testicular disease at diagnosis of childhood acute lymphoblastic leukemia: lack of therapeutic role of local irradiation

Overt testicular disease at diagnosis of childhood acute lymphoblastic leukemia: lack of therapeutic role of local irradiation

Leptomeningeal metastases

Learning difficulties in children treated for acute lymphoblastic leukaemia (ALL)

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