Cranial radiation necessary for CNS prophylaxis in pediatric NHL
The records of 95 consecutive children less than or equal to 21 years of age with previously untreated diffuse histology NHL registered in our protocols from 1978 to 1983 were reviewed. Seventy-nine patients were considered eligible for analysis. The histologic subtypes represented included lymphoblastic (LB) 37%; histiocytic (DHL) 29%; undifferentiated (DU) 19%; poorly differentiated (DPDL) 9%; and unclassified (UNHL) 6%. Distribution of the patients according to stage showed Stage I, 0%; Stage II, 11%; Stage III, 53%; Stage IV, 36%. Four different Memorial Hospital protocols for systemic chemotherapy were used (LSA2L2 73%; L10 9%; L17 10%; L17M 8%); however, the IT (intrathecal) chemotherapy was uniform (Methotrexate: 6.0-6.25 mg/M2 per treatment course) and was included in the induction, consolidation, and maintenance phases of all treatment protocols. Cranial radiation was included in the induction, consolidation, and maintenance phases of all treatment protocols. Cranial radiation was not included in the CNS prophylaxis program. The overall median time of follow-up was 43 months. The overall CNS relapse rate was 6.3%; however, the incidence of CNS lymphoma presenting as the first isolated site of relapse in patients in otherwise complete remission (minimum follow-up of 19 months with 97% of patients off treatment) was only 1/58 (1.7%). Our data suggest that IT chemotherapy when given in combination with modern aggressive systemic combination chemotherapy, and without cranial radiation appears to be a highly effective modality for CNS prophylaxis regardless of stage, histology, or bone marrow or mediastinal involvement. (Abstract Truncated)
- Research Organization:
- Memorial Sloan-Kettering Cancer Center, New York, NY
- OSTI ID:
- 6788827
- Journal Information:
- Int. J. Radiat. Oncol., Biol. Phys.; (United States), Vol. 3
- Country of Publication:
- United States
- Language:
- English
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Related Subjects
CENTRAL NERVOUS SYSTEM
LYMPHOMAS
COMBINED THERAPY
BRAIN
CHILDREN
CLASSIFICATION
HISTOLOGY
METHOTREXATE
PATIENTS
AGE GROUPS
ANTIMETABOLITES
BODY
DISEASES
DRUGS
NEOPLASMS
NERVOUS SYSTEM
ORGANS
THERAPY
550603* - Medicine- External Radiation in Therapy- (1980-)
550600 - Medicine