Influence of Cranial Radiotherapy on Outcome in Children With Acute Lymphoblastic Leukemia Treated With Contemporary Therapy
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Implication
Meta-analysis reveals minimal relapse reduction from cranial radiotherapy in pediatric acute lymphoblastic leukemia, indicating it can be safely omitted in modern protocols.
Key Points
- To determine whether cranial radiotherapy prevents disease relapse in any specific subgroup of children treated for acute lymphoblastic leukemia with contemporary protocols.
- Analyzed aggregate relapse and survival data from 16,623 patients aged 1 to 18 years with newly diagnosed ALL treated across 10 international cooperative study groups between 1996 and 2007.
- Evaluated event-free survival, isolated or any CNS relapse, and isolated bone marrow relapse across high-risk patient subgroups using a random effects meta-analysis model with cranial radiotherapy as a dichotomous covariate.
- Cranial radiotherapy was associated with a lower rate of isolated CNS relapse only in patients presenting with overt CNS disease at diagnosis (4% with CRT vs. 17% without CRT; P = .02), alongside a non-significant trend for any CNS relapse (7% vs. 17%; P = .09).
- Overall event rates in patients with initial CNS involvement did not differ significantly between treatment groups (32% [95% CI, 26% to 39%] with CRT vs. 34% [95% CI, 19% to 54%] without CRT; P = .8).
Cite This Study
Vora et al. (2016) studied this question.