Influence of Cranial Radiotherapy on Outcome in Children With Acute Lymphoblastic Leukemia Treated With Contemporary Therapy
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Influence of Cranial Radiotherapy on Outcome in Children With Acute Lymphoblastic Leukemia Treated With Contemporary Therapy. / Vora, Ajay; Andreano, Anita; Pui, Ching-Hon; Hunger, Stephen P; Schrappe, Martin; Moericke, Anja; Biondi, Andrea; Escherich, Gabriele; Silverman, Lewis B; Goulden, Nicholas; Taskinen, Mervi; Pieters, Rob; Horibe, Keizo; Devidas, Meenakshi; Locatelli, Franco; Valsecchi, Maria Grazia.
in: J CLIN ONCOL, Jahrgang 34, Nr. 9, 20.03.2016, S. 919-26.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
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TY - JOUR
T1 - Influence of Cranial Radiotherapy on Outcome in Children With Acute Lymphoblastic Leukemia Treated With Contemporary Therapy
AU - Vora, Ajay
AU - Andreano, Anita
AU - Pui, Ching-Hon
AU - Hunger, Stephen P
AU - Schrappe, Martin
AU - Moericke, Anja
AU - Biondi, Andrea
AU - Escherich, Gabriele
AU - Silverman, Lewis B
AU - Goulden, Nicholas
AU - Taskinen, Mervi
AU - Pieters, Rob
AU - Horibe, Keizo
AU - Devidas, Meenakshi
AU - Locatelli, Franco
AU - Valsecchi, Maria Grazia
N1 - © 2016 by American Society of Clinical Oncology.
PY - 2016/3/20
Y1 - 2016/3/20
N2 - PURPOSE: We sought to determine whether cranial radiotherapy (CRT) is necessary to prevent relapse in any subgroup of children with acute lymphoblastic leukemia (ALL).PATIENTS AND METHODS: We obtained aggregate data on relapse and survival outcomes for 16,623 patients age 1 to 18 years old with newly diagnosed ALL treated between 1996 and 2007 by 10 cooperative study groups from around the world. The proportion of patients eligible for prophylactic CRT varied from 0% to 33% by trial and was not related to the proportion eligible for allogeneic stem-cell transplantation in first complete remission. Using a random effects model, with CRT as a dichotomous covariate, we performed a single-arm meta-analysis to compare event-free survival and cumulative incidence of isolated or any CNS relapse and isolated bone marrow relapse in high-risk subgroups of patients who either did or did not receive CRT.RESULTS: Although there was significant heterogeneity in all outcome end points according to trial, CRT was associated with a reduced risk of relapse only in the small subgroup of patients with overt CNS disease at diagnosis, who had a significantly lower risk of isolated CNS relapse (4% with CRT v 17% without CRT; P = .02) and a trend toward lower risk of any CNS relapse (7% with CRT v 17% without CRT; P = .09). However, this group had a relatively high rate of events regardless of whether or not they received CRT (32% [95% CI, 26% to 39%] v 34% [95% CI, 19% to 54%]; P = .8).CONCLUSION: CRT does not have an impact on the risk of relapse in children with ALL treated on contemporary protocols.
AB - PURPOSE: We sought to determine whether cranial radiotherapy (CRT) is necessary to prevent relapse in any subgroup of children with acute lymphoblastic leukemia (ALL).PATIENTS AND METHODS: We obtained aggregate data on relapse and survival outcomes for 16,623 patients age 1 to 18 years old with newly diagnosed ALL treated between 1996 and 2007 by 10 cooperative study groups from around the world. The proportion of patients eligible for prophylactic CRT varied from 0% to 33% by trial and was not related to the proportion eligible for allogeneic stem-cell transplantation in first complete remission. Using a random effects model, with CRT as a dichotomous covariate, we performed a single-arm meta-analysis to compare event-free survival and cumulative incidence of isolated or any CNS relapse and isolated bone marrow relapse in high-risk subgroups of patients who either did or did not receive CRT.RESULTS: Although there was significant heterogeneity in all outcome end points according to trial, CRT was associated with a reduced risk of relapse only in the small subgroup of patients with overt CNS disease at diagnosis, who had a significantly lower risk of isolated CNS relapse (4% with CRT v 17% without CRT; P = .02) and a trend toward lower risk of any CNS relapse (7% with CRT v 17% without CRT; P = .09). However, this group had a relatively high rate of events regardless of whether or not they received CRT (32% [95% CI, 26% to 39%] v 34% [95% CI, 19% to 54%]; P = .8).CONCLUSION: CRT does not have an impact on the risk of relapse in children with ALL treated on contemporary protocols.
U2 - 10.1200/JCO.2015.64.2850
DO - 10.1200/JCO.2015.64.2850
M3 - SCORING: Journal article
C2 - 26755523
VL - 34
SP - 919
EP - 926
JO - J CLIN ONCOL
JF - J CLIN ONCOL
SN - 0732-183X
IS - 9
ER -
