20. Central nervous system-directed therapy in childhood lymphoblastic leukemia

  1. Ross Pinkerton MB, BCh, BaO, MD Executive Director, Division of Oncology2,
  2. Ananth Shankar MD, FRCPCH Consultant in Paediatric and Adolescent Oncology3 and
  3. Katherine K. Matthay BA, MD Mildred V. Strouss Professor of Translational Oncology, Director, Pediatric Hematology-Oncology4
  1. Ananth Shankar

Published Online: 8 MAY 2013

DOI: 10.1002/9781118625309.ch20

Evidence-Based Pediatric Oncology

Evidence-Based Pediatric Oncology

How to Cite

Shankar, A. (2013) Central nervous system-directed therapy in childhood lymphoblastic leukemia, in Evidence-Based Pediatric Oncology (eds R. Pinkerton, A. Shankar and K. K. Matthay), John Wiley & Sons, Ltd, Oxford. doi: 10.1002/9781118625309.ch20

Editor Information

  1. 2

    Royal Children's Hospital, Children's Health Queensland, Brisbane, QLD, Australia

  2. 3

    University College London Hospitals NHS Foundation Trust London, UK

  3. 4

    Department of Pediatrics, UCSF School of Medicine and, UCSF Benioff Children's Hospital, San Francisco, CA, USA

Author Information

  1. University College London Hospitals NHS Foundation Trust, London, UK

Publication History

  1. Published Online: 8 MAY 2013
  2. Published Print: 20 MAY 2013

ISBN Information

Print ISBN: 9780470659649

Online ISBN: 9781118625309

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Keywords:

  • central nervous system (CNS);
  • childhood lymphoblastic leukaemia;
  • intrathecal therapy;
  • irradiation;
  • methotrexate

Summary

Prior to 1960, when there was no presymptomatic central nervous system (CNS) directed therapy, > 50% of children relapsed in the CNS. Many collaborative study groups conducted randomized trials of pre-symptomatic or prophylactic cranial radiotherapy (CRT) or craniospinal irradiation (CSRT) aimed at optimizing the effect of chemo-radiation in this setting but minimizing toxicity, particularly late sequelae. The chapter summarizes the randomized trials of pre-symptomatic or prophylactic cranial radiotherapy (CRT) or CSRT aimed at optimizing the effect of chemo-radiation in this setting but minimizing toxicity. These include the Children's Cancer Group (CCG) trials, the UK ALL VII trial, The Brazilian ALL Study Group trial GBTLI-80, and the The Alin C-9 trial. Clarke performed a meta-analysis of 43 randomized trials in childhood lymphoblastic leukaemia (ALL). Primary outcome measures were event-free survival (EFS) and overall survival (OS) from date of randomization. Finally, the chapter summarizes the results of the trials.