Comparison of intermediate-dose methotrexate with cranial irradiation for the post-induction treatment of acute lymphocytic leukemia in children

Journal Article · Thu Mar 03 04:00:00 EST 1983 · N.Engl. J. Med.; (United States)

DOI:https://doi.org/10.1056/NEJM198303033080902· OSTI ID:5777819

Freeman, A I; Weinberg, V; Brecher, M L; Jones, B; Glicksman, A S; Sinks, L F; Weil, M; Pleuss, H; Hananian, J; Burgert, Jr, E O

The authors compared two regimens with respect to their ability to prolong disease-free survival in 506 children and adolescents with acute lymphocytic leukemia. All responders to induction therapy were randomized to treatment with 2400 rad of cranial irradiation plus intrathecal methotrexate or to treatment with intermediate-dose methotrexate plus intrathecal methotrexate, as prophylaxis for involvement of the central nervous system and other sanctuary areas. Complete responders were stratified into either standard-risk or increased-risk groups on the basis of age and white-cell count at presentation. Among patients with standard risk, hematologic relapses occurred in 9 of 117 given methotrexate and 24 of 120 given irradiation. The rate of central-nervous-system relapse was higher in the methotrexate group (23 of 117) than in the irradiation group. Among patients with increased risk, radiation offered greater protection to the central nervous system than methotrexate; there was no difference in the rate of hematologic relapse. Methotrexate offered better protection against systemic relapse in standard-risk patients and better protection against testicular relapse overall, but it offered less protection against relapses in the central nervous system than cranial irradiation.

• Research Organization: Roswell Park Memorial Inst., Buffalo, NY
• OSTI ID: 5777819
• Journal Information: N.Engl. J. Med.; (United States), Journal Name: N.Engl. J. Med.; (United States) Vol. 308:9; ISSN NEJMA
• Country of Publication: United States
• Language: English

Related Subjects

550603* -- Medicine-- External Radiation in Therapy-- (1980-)
62 RADIOLOGY AND NUCLEAR MEDICINE
AGE GROUPS
ANTIMETABOLITES
CENTRAL NERVOUS SYSTEM
CHEMOTHERAPY
CHILDREN
DISEASES
DRUGS
EVALUATION
EXTERNAL IRRADIATION
HEMIC DISEASES
IRRADIATION
LEUKEMIA
MEDICINE
METHOTREXATE
NEOPLASMS
NERVOUS SYSTEM
NUCLEAR MEDICINE
PARTIAL BODY IRRADIATION
RADIOLOGY
RADIOTHERAPY
RISK ASSESSMENT
THERAPY