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Title: Comprehensive Craniospinal Radiation for Controlling Central Nervous System Leukemia

Purpose: To determine the benefit of radiation therapy (RT) in resolution of neurologic symptoms and deficits and whether the type of RT fields influences central nervous system (CNS) control in adults with CNS leukemia. Methods and Materials: A total of 163 adults from 1996 to 2012 were retrospectively analyzed. Potential associations between use of radiation and outcome were investigated by univariate and multivariate analysis. Results: The median survival time was 3.8¬†months after RT. Common presenting symptoms were headache in 79 patients (49%), cranial nerve VII deficit in 46 (28%), and cranial nerve II deficit in 44 (27%). RT was delivered to the base of skull in 48 patients (29%), to the whole brain (WB) in 67 (41%), and to the craniospinal axis (CS) in 48 (29%). Among 149 patients with a total of 233 deficits, resolution was observed in 34 deficits (15%), improvement in 126 deficits (54%), stability in 34 deficits (15%), and progression in 39 deficits (17%). The 12-month CNS progression-free survival was 77% among those receiving CS/WB and 51% among those receiving base of skull RT (P=.02). On multivariate analysis, patients who did not undergo stem cell transplantation after RT and base of skull RT were associated withmore » worse CNS progression-free survival. Conclusions: Improvement or resolution of symptoms occurred in two thirds of deficits after RT. Comprehensive radiation to the WB or CS seems to offer a better outcome, especially in isolated CNS involvement.« less
Authors:
;  [1] ;  [2] ;  [1] ; ;  [3] ;  [2] ; ; ;  [1] ;  [2] ;  [4] ; ; ;  [1] ;  [1]
  1. Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States)
  2. Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States)
  3. Department of Stem Cell Transplantation, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States)
  4. Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States)
Publication Date:
OSTI Identifier:
22420504
Resource Type:
Journal Article
Resource Relation:
Journal Name: International Journal of Radiation Oncology, Biology and Physics; Journal Volume: 90; Journal Issue: 5; Other Information: Copyright (c) 2014 Elsevier Science B.V., Amsterdam, The Netherlands, All rights reserved.; Country of input: International Atomic Energy Agency (IAEA)
Country of Publication:
United States
Language:
English
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; ADULTS; CENTRAL NERVOUS SYSTEM; LEUKEMIA; MULTIVARIATE ANALYSIS; PATIENTS; RADIOTHERAPY; SKULL; STEM CELLS; SURVIVAL TIME