Childhood Leukemia Treatment: Is Cranial Irradiation Necessary?

With intensified intrathecal and systemic chemotherapy, omission of prophylactic irradiation did not compromise survival.

Because treatment for childhood acute lymphoblastic leukemia (ALL) has attained 5-year event-free survival (EFS) rates of approximately 80%, research is now aimed at attenuating treatment-related late effects in patients who are expected to achieve good outcomes. One such approach, now part of most treatment regimens, has been to reduce prophylactic doses of cranial irradiation for the 20% to 25% of patients at high risk for central nervous system (CNS) recurrence. However, even lower doses of cranial irradiation have been associated with late complications, including secondary cancers, excess mortality, and adverse neuropsychological outcomes.

To assess whether prophylactic cranial irradiation can be completely eliminated without compromisi…

Reviewing Author

Michael G. Douvas, MD