Treating Childhood Acute Lymphoblastic Leukemia without Cranial Irradiation

This large trial of acute lymphoblastic leukemia in children aimed to determine whether intensive systemic and intrathecal chemotherapy could obviate the need for prophylactic central nervous system irradiation, which is associated with distressing late complications. The results show that, with meticulous monitoring of responses and toxic effects, it is possible not only to avoid cranial irradiation but also to improve the overall outcome. This large trial of acute lymphoblastic leukemia in children aimed to determine whether intensive systemic and intrathecal chemotherapy could obviate the need for prophylactic central nervous system irradiation. The results show that it is possible not only to avoid cranial irradiation but also to improve the overall outcome. Clinical trials have yielded 5-year event-free survival rates as high as 79 to 82% among children with acute lymphoblastic leukemia (ALL). 1 – 3 A major challenge is to reduce treatment-related late effects, which can occur in more than two thirds of long-term survivors. 4 In a growing proportion of patients, prophylactic cranial irradiation, once a standard treatment, is being replaced by intrathecal and systemic chemotherapy to reduce radiation-associated late complications such as second cancers, cognitive deficits, and endocrinopathy. 4 – 8 Two pediatric clinical trials tested whether prophylactic cranial irradiation could be completely omitted from treatment. 9 , 10 Although the cumulative risks of isolated central . . .