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For Kids With Leukemia, Radiation May Be Safe to Skip
Date:6/24/2009

ut now were being treated with systemic chemotherapy or chemotherapy administered intrathecally (through a lumbar puncture). They were compared with 56 youngsters who had been treated with prophylactic cranial radiation for ALL.

The five-year remission rate for the chemotherapy-only group was 90.8 percent, vs. 73 percent for the group also given radiation treatment. Eleven children in the chemotherapy group had central nervous system relapses, but all were able to achieve a second remission.

"With effective chemotherapy, prophylactic cranial irradiation can be safely omitted in all children with acute lymphoblastic leukemia," Pui said.

Dr. A. Kim Ritchey, chief of the division of pediatric hematology/oncology at Children's Hospital of Pittsburgh, said that the study "may not be the final answer, but my personal bias has always been to decrease radiation as much as possible."

"The treatment of leukemia has become more and more individualized, and high-risk patients can get more therapy, sometimes even based on their genotype, and this study makes the point that you can attempt to treat high-risk patients without cranial radiation," he said. "This is the type of data we love to see in pediatric oncology because we're very concerned about the effects of treatment after the cure."

More information

The American Cancer Society has more on the treatment of childhood acute lymphoblastic leukemia.



SOURCES: Ching-Hon Pui, M.D., chairman, department of oncology, St. Jude Children's Research Hospital, Memphis, Tenn.; A. Kim Ritchey, M.D., chief, division of pediatric hematology/oncology, Children's Hospital of Pittsburgh; June 25, 2009, New England Journal of Medicine


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