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Functional neurological outcome in leukaemic children receiving repeated cranial irradiation
A Davidson1, J Childs, J W Hopewell
1Paediatric Department, Royal Marsden Hospital, Sutton, Surrey, UK.
Insights
Children treated for acute lymphoblastic leukemia (ALL) with cranial radiotherapy before bone marrow transplant (BMT) generally achieve good long-term educational and employment outcomes. However, younger age, CNS relapse, and higher radiation doses were associated with poorer functional outcomes.
Area of Science:
- Pediatric Oncology
- Hematology
- Radiation Oncology
Background:
- Children with acute lymphoblastic leukemia (ALL) often undergo cranial radiotherapy before bone marrow transplant (BMT).
- Long-term functional outcomes in these patients require thorough investigation to identify risk factors.
- Assessing educational and employment histories provides crucial data on survivorship quality.
Purpose of the Study:
- To evaluate the long-term educational and employment outcomes of pediatric ALL survivors treated with cranial radiotherapy and BMT.
- To identify specific risk factors associated with adverse functional outcomes in this patient cohort.
Main Methods:
- Retrospective analysis of 69 consecutive patients with ALL who received cranial radiotherapy prior to BMT.
- Median follow-up of 24 survivors was 4 years and 2 months.
- Individual risk factors, including biological effective radiation doses, were analyzed.
Main Results:
- No central nervous system (CNS) treatment-related mortality was observed.
- All 24 survivors achieved normal educational or employment status.
- Three survivors with a history of CNS relapse required remedial teaching.
Conclusions:
- Long-term functional outcomes in pediatric ALL survivors treated with cranial radiotherapy and BMT are generally favorable.
- While overall outcomes are positive, younger age at treatment, CNS relapse, and higher cranial irradiation doses represent significant risk factors for poorer functional outcomes.
Abstract:
Long-term outcome defined by educational or employment history has been recorded in a group of children with acute lymphoblastic leukaemia (ALL) who received cranial radiotherapy at some stage prior to TBI conditioned bone marrow transplant (BMT). Median follow-up in 24 survivors of 69 consecutive patients was 4 years and 2 months. Individual risk factors for poor functional outcome were considered, including calculations of biological effective radiation doses. There was no incidence of CNS treatment-related mortality. All survivors are in normal school or employment, although three who had CNS relapse are receiving remedial teaching. No individual risk factors could be identified but the worst outcome was seen in children who were of young age at the time of initial treatment, who suffered CNS relapse and who had received the highest total dose of cranial irradiation.