Comprehensive craniospinal radiation for controlling central nervous system leukemia.

Area of Science:

• Neurology
• Oncology
• Radiation Oncology

Background:

• Leukemia can infiltrate the central nervous system (CNS), leading to significant neurologic symptoms and deficits.
• Effective management of CNS leukemia requires strategies to control disease spread and alleviate associated symptoms.

Purpose of the Study:

• To evaluate the efficacy of radiation therapy (RT) in resolving neurologic symptoms in adults with CNS leukemia.
• To determine if the extent of RT fields influences CNS disease control.

Main Methods:

• Retrospective analysis of 163 adult patients treated between 1996 and 2012.
• Investigated associations between RT application and patient outcomes using univariate and multivariate analyses.
• Classified RT fields into base of skull, whole brain (WB), and craniospinal axis (CS).

Main Results:

• Two-thirds of 233 neurologic deficits showed improvement or resolution after RT.
• 12-month CNS progression-free survival was higher with CS/WB RT (77%) compared to base of skull RT (51%).
• Base of skull RT and lack of stem cell transplantation post-RT were linked to worse CNS progression-free survival.

Conclusions:

• RT provides symptomatic benefit in a majority of patients with CNS leukemia.
• Comprehensive RT (WB or CS) appears more effective for CNS control, particularly in cases of isolated CNS involvement.
• RT field selection is a critical factor in managing CNS leukemia outcomes.