Influence of Cranial Radiotherapy on Outcome in Children With Acute Lymphoblastic Leukemia Treated With Contemporary Therapy
Year: 2016
Type: article
Abstract: PURPOSE: We sought to determine whether cranial radiotherapy (CRT) is necessary to prevent relapse in any subgroup of children with acute lymphoblastic leukemia (ALL). PATIENTS AND METHODS: We obtained aggregate data on relapse and survival outcomes for 16,623 patients age 1 to 18 years old with newly diagnosed ALL treated between 1996 and 2007 by 10 cooperative study groups from around the world. The proportion of patients eligible for prophylactic CRT varied from 0% to 33% by trial and was not related to the proportion eligible for allogeneic stem-cell transplantation in first complete remission. Using a random effects model, with CRT as a dichotomous covariate, we performed a single-arm meta-analysis to compare event-free survival and cumulative incidence of isolated or any CNS relapse and isolated bone marrow relapse in high-risk subgroups of patients who either did or did not receive CRT. RESULTS: Although there was significant heterogeneity in all outcome end points according to trial, CRT was associated with a reduced risk of relapse only in the small subgroup of patients with overt CNS disease at diagnosis, who had a significantly lower risk of isolated CNS relapse (4% with CRT v 17% without CRT; P = .02) and a trend toward lower risk of any CNS relapse (7% with CRT v 17% without CRT; P = .09). However, this group had a relatively high rate of events regardless of whether or not they received CRT (32% [95% CI, 26% to 39%] v 34% [95% CI, 19% to 54%]; P = .8). CONCLUSION: CRT does not have an impact on the risk of relapse in children with ALL treated on contemporary protocols.
Source: Journal of Clinical Oncology
Language: English
Field: Medicine
Domain: Health Sciences
Open Access status: green
Funders: American Lebanese Syrian Associated Charities, Leukaemia and Lymphoma Research, European Commission, Ministry of Health, Labour and Welfare, National Institutes of Health, Medical Research Council, National Cancer Institute, National Institute of General Medical Sciences, National Center for Advancing Translational Sciences, FP7 Health
Awards: G1772308789, G1860110607, G1972739234, Together: Transforming and Translating Discovery to Improve Health, G2135062745, EUROPEAN NETWORK for CANCER research in CHILDREN and ADOLESCENTS, G2554726104, G2901481919, G301932103, G3345260134, Pharmacogenomics of Childhood Leukemia ALL, Children's Oncology Group Statistics and Data Center, G46020690, G5075990039, G609259107, PHARMACOGENOMICS OF CHILDHOOD LEUKEMIA (ALL), G7926827615, G865138149, G9000048645, G9000086855, G9000133408, G9000150487, G9000211056, G9000215840, G9000255358, G9000285815, Cancer Center Support Grant (CCSG), G997771125
OpenAlex ID: W2238009057