Outcomes of a randomized trial of hyperfractionated cranial radiation therapy for treatment of high-risk acute lymphoblastic leukemia: therapeutic efficacy and neurotoxicity
Waber, Deborah P.
Silverman, Lewis B.
Gelber, Richard D.
Levy, Donna E.
Goldwasser, Meredith A.
Tarbell, Nancy J.
Sallan, Stephen E.
MetadataShow full item record
Purpose We evaluated 8-year survival and late neuropsychologic toxicity in children with acute lymphoblastic leukemia treated in a randomized clinical trial to test whether hyperfractionated (twice daily) cranial radiation therapy (CRT) can reduce incidence and severity of late toxicities associated
with 18 Gy of CRT. Patients and Methods Between 1987 and 1995, 369 children treated on two consecutive Dana-Farber Cancer Institute Consortium protocols for high-risk acute lymphoblastic leukemia were randomly assigned to conventionally fractionated CRT (CFX) or hyperfractionated CRT (HFX) to a total dose of 18 Gy. Neuropsychologic testing was completed for 125 of 287 children in continuous complete remission. Event-free and overall survival, as well as neuropsychologic function, were compared for the two arms of the protocol. Results Eight-year event-free survival ( SE) was 80% 3% for children randomly assigned to CFX and 72% 3% for HFX (P .06). Overall survival was 85% 3% for CFX and 78% 3% for HFX (P .06). CNS relapses occurred in 2.8% of patients receiving CFX and 2.7% receiving HFX (P .99). Cognitive function for both groups was solidly in the average range, with no group differences in intelligence, academic achievement, visuospatial reasoning, or verbal learning. Children on the HFX arm exhibited a modest advantage for visual memory (P .05). Conclusion HFX provides no benefit in terms of cognitive late effects and may compromise antileukemic efficacy. HFX should not be substituted for conventionally dosed CRT in children who require radiation therapy for treatment of acute lymphoblastic leukemia.
Is part ofJournal of Clinical Oncology, 2004, vol. 22, núm. 13, p. 2701-2707
Showing items related by title, author, creator and subject.
Sequence analysis of clonal immunoglobulin and T-cell receptor gene rearrangements in children with acute lymphoblastic leukemia at diagnosis and at relapse: implications for pathogenesis and for the clinical utility of PCR-based methods of minimal residual disease detection Li, Aihong; Zhou, Jianbiao; Zuckerman, David; Dalton, Virginia; Lyons, Cheryl; Silverman, Lewis B.; Sallan, Stephen E.; Gribben, John G.; Rué i Monné, Montserrat (American Society of Hematology, 2003)Immunoglobulin (Ig) and T-cell receptor (TCR) gene rearrangements provide clonal markers useful for diagnosis and measurement of minimal residual disease (MRD) in acute lymphoblastic leukemia (ALL). We analyzed the ...
Utilization of Ig heavy chain variable, diversity, and joining gene segments in children with B-lineage acute lymphoblastic leukemia: implications for the mechanisms of VDJ recombination and for pathogenesis Li, Aihong; Rué i Monné, Montserrat; Zhou, Jianbiao; Wang, Hongjun; Goldwasser, Meredith A.; Neuberg, Donna; Dalton, Virginia; Zuckerman, David; Lyons, Cheryl; Silverman, Lewis B.; Sallan, Stephen E.; Gribben, John G. (American Society of Hematology, 2004)Sequence analysis of the immunoglobulin heavy chain genes (IgH) has demonstrated preferential usage of specific variable (V), diversity (D), and joining (J) genes at different stages of B-cell development and in B-cell ...
Effectivity of high definition transcranial direct current stimulation (HD-tDCS) combined with therapeutic exercise treatment in athletic adult patients with chronic ankle instability. Prospective Double blinded randomized controlled trial Romero Gómez, Carlos (2020)Clinical research question: Is more effective therapeutic exercise combined with high definition transcranial direct current stimulation (HD-tDCS) than therapeutic exercise combined with sham HD-tDCS in athletic adult ...