CNS-directed therapy in young XXXX with @entity981 : High-dose methotrexate versus cranial irradiation.

@entity1 @entity981 @entity1313 @entity2033 @entity1778 @entity1500 @entity1499
BACKGROUND: Prophylactic use of cranial radiation therapy (CRT) in young @entity1 with @entity981 ( @entity981 ) is associated with significant long-term morbidity. Therefore, current treatment protocols for pediatric B-precursor @entity981 have abandoned prophylactic CRT in favor of intrathecal chemotherapy, combined with either high-dose @entity1499 infusions ( @entity2033 - @entity1500 ) or intensive systemic chemotherapy. In contrast, prophylactic CRT continues to be used in @entity1 with @entity981 ( @entity981 ), who historically have had an inferior prognosis. We conducted a retrospective cohort study to determine the effect on survival of substituting @entity2033 - @entity1500 for CRT in young @entity1 with @entity981 , a group that faces a high risk of long-term sequelae from CRT. PROCEDURE: Twenty-six @entity1 , diagnosed with @entity981 between the ages of 1 and 5 years, were treated on the same high-risk @entity1778 protocol. Central nervous system (CNS) directed therapy consisted of either CRT (1,800 cGy) or @entity2033 - @entity1500 (three doses of 8 g/m2), depending on the treatment era in which @entity1 were diagnosed. RESULTS: Of the 24 @entity1 who entered remission, 12 received CRT and 12 received @entity2033 - @entity1500 . Five-year event-free survival (EFS) (+/-SE) was 92 +/- 8% in the @entity2033 - @entity1500 group versus 75 +/- 13% in the CRT group (P=0.23). Five-year overall survival (OS) was 100% in the @entity2033 - @entity1500 group versus 75 +/- 13% in the CRT group (P=0.07). There were no CNS recurrences in the @entity2033 - @entity1500 group. One @entity1 treated with CRT developed a @entity1313 . CONCLUSIONS: The use of @entity2033 - @entity1500 instead of CRT as CNS-directed therapy in very young @entity1 with @entity981 does not compromise survival, while avoiding the adverse long-term effects of cranial irradiation.
