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["Preventive" cranial irradiation in acute lymphoblastic leukemia in childhood]
Insights
This study combined chemotherapy and radiation for acute lymphoblastic leukemia in children. The treatment achieved a 50% three-year survival rate, offering hope for young patients.
Area of Science:
- Pediatric Oncology
- Hematology
- Clinical Research
Background:
- Acute lymphoblastic leukemia (ALL) is a significant childhood cancer.
- Effective treatment protocols are crucial for improving patient outcomes.
- Previous studies informed combined therapy approaches.
Purpose of the Study:
- To evaluate the efficacy of a combined cytostatic and cranial radiation therapy for childhood acute lymphoblastic leukemia.
- To assess survival rates and remission status in pediatric ALL patients treated with this combined approach.
- To identify prognostic factors influencing treatment outcomes.
Main Methods:
- A cohort of 147 children with acute lymphoblastic leukemia (ALL) were treated between May 1971 and January 1974.
- Initial treatment involved cytostatic therapy to achieve remission, followed by cranial irradiation (1500-2400 rd) and intrathecal methotrexate.
- Long-term cytostatic therapy was administered post-irradiation.
Main Results:
- A 94% remission rate was achieved within 4-6 weeks of initial cytostatic treatment.
- The combined therapy resulted in a 50% three-year survival rate (8/16) and a 44% complete remission rate (7/16) in a subset of patients.
- Prognostic factors for a less favorable outcome included initial high leukocyte count (>50,000/mm³), age over ten years, and presence of leukemic cells in cerebrospinal fluid.
Conclusions:
- Combined cytostatic and radiation therapy, including intrathecal methotrexate, can achieve significant remission and survival rates in pediatric acute lymphoblastic leukemia.
- Early identification of prognostic indicators is essential for tailoring treatment strategies.
- The treatment protocol showed comparable prognosis for both genders.
Abstract:
In accordance with the recommendations of Pinkel, 147 children with acute lymphoblastic leukemia were treated by a combined cytostatic and radiation therapy during a joint study between May 1971 and Jan. 1, 1974. After a primary cytostatical treatment which brought about a remission of 94% of the patients within four to six weeks, the cranial irradiation was performed, depending on age, with a focal dose of 1500 up to 2400 rd in the course of three or four weeks. Simultaneously, the patients were given methotrexate intrathecally which was followed, later on, by a long-term therapy with cytostatics. By means of this combined treatment, a three-year survival was obtained in 50% (8 of 16) and a complete remission in 44% (7 of 16). The prognosis is the same for boys as for girls. A less favorable prognosis concerns the patients with an initial leukocytosisf more than 50 000 leukocytes/mm3 of blood, an age of more than ten years, and leukemic cells already demonstrable in the cerebrospinal fluid.