Computerized tomography scan findings in children with acute lymphocytic leukemia treated with three different methods of central nervous system prophylaxis

Brecher, Martin L.; Berger, Paul E.; Freeman, Arnold I.; Krischer, Jeffrey; Boyett, James M.; Glicksman, Arvin S.; Foreman, E; Harris, Michael B.; Jones, Barbara; Cohen, Michael E.; Duffner, Patricia K.; Rowland, Julia H.; Huang, Yun-Peng; Batnitzky, Solomon

doi:10.1002/1097-0142(19851115)56:10<2430::aid-cncr2820561017>3.0.co;2-3

Cited by 34 publications

(12 citation statements)

References 18 publications

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“…Symptoms include cognitive decline, behavioral changes, gait abnormalities, and seizures. The use of radiotherapy with chemotherapy, especially methotrexate, may enhance the likelihood of developing leukoencephalopathy but may not be clinically significant because of the very limited prognosis of patients with LM [73].…”

Section: Neurotoxicity From Treatment Of Lmmentioning

confidence: 99%

Diagnosis and Management of Central Nervous System Metastases from Breast Cancer

Chang

2003

The Oncologist

146

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The brain, cranial nerves, leptomeninges, spinal cord, and eye compose the central nervous system (CNS) and are at risk for the development of metastases from breast cancer. Such metastases are diagnosed on the basis of clinical suspicion and substantiated by neuroimaging, resection when indicated, and sampling of cerebrospinal fluid when leptomeningeal metastasis (LM) is suspected. Treatment is aimed at palliation of symptoms and preservation of neurologic function. Historically, conventional radiation therapy has been the mainstay of palliative treatment for brain, cranial nerve, spinal cord, and ocular metastases. However, additional treatment options for brain metastases have been brought about by technological advances in surgery to resect brain metastases, and stereotactic radiosurgery (SRS) to focally irradiate metastases, both of which have been substantiated by data from randomized trials. Ongoing research is aimed at refining criteria to select which patients with brain metastases should undergo surgery and SRS and how these focal therapies should be optimally integrated with whole-brain radiotherapy. Therapy for LM must carefully balance the potential risks and perceived benefits associated with CNS-directed therapies. Despite advances in neuroimaging, surgery, and radiation therapy, novel treatments are needed to improve the effectiveness of treatments for CNS metastases, especially LM, while reducing attendant neurotoxicity.

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Section: Neurotoxicity From Treatment Of Lmmentioning

confidence: 99%

Diagnosis and Management of Central Nervous System Metastases from Breast Cancer

Chang

2003

The Oncologist

146

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“…Irradiated patients presented more frequent focal white matter necrosis, brain atrophy, calcifications and grey matter changes in radiological examinations. On the other hand, there are studies which report no significant differences between the irradiated and nonirradiated patients [12][13][14][15].…”

Section: Introductionmentioning

confidence: 99%

“…Since the 1980s most of the children have been prophylactically irradiated with a maximum dose of only 18 Gy or were treated with systemic medium-high-dose methotrexate (SMHDMTX) and ITMTX without CI. However, the published studies often investigated children receiving CI with 24 Gy [11,16,17].…”

Section: Introductionmentioning

confidence: 99%

CNS late effects after ALL therapy in childhood. Part I: Neuroradiological findings in long-term survivors of childhood ALL—an evaluation of the interferences between morphology and neuropsychological performance

Hertzberg¹,

Huk

Ueberall³

et al. 1997

Med. Pediatr. Oncol.

105

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The effect of cranial irradiation on possible therapy‐induced morphological central nervous system (CNS) side effects of children cured from acute lymphoblastic leukemia (ALL) is controversially discussed. In a retrospective multicenter study, 118 former ALL patients in first continous remission were investigated using cranial computerised tomography (CCT) or magnetic resonance imaging (MRI) scans to evaluate CNS related impairments. Corresponding to the different kinds of CNS prophylaxis, the patient sample was divided: group A (n = 39) receiving intrathecal methotrexate (ITMTX) and systemical medium‐high‐dose methotrexate (SMHDMTX), group B (n = 41) cranial irradiated (in mean 16.8 Gy) and administering ITMTX and SMHDMTX, group C (n = 38) irradiated (in mean 17.1 Gy) and getting ITMTX. Pathologic scans showed atrophy, leukoencephalopathy, calcifications or grey matter changes. These findings were compared with the neuropsychological test results. Abnormal MRI or CCT scans were found in 61/118 patients (51.7%). Fifteen belonged to group A (38.5%), 23 to B (56.1%) and 23 to C (60.5%). Patients with definite CNS changes show reduced neuropsychological test results. The prevalence of brain alterations seems to appear twice increased after lengthening the post‐therapeutic interval in irradiated patients as in nonirradiated patients. Irradiated patients with an age younger than 2 years at diagnosis may show a lower prevalence for developing CNS alterations. CNS alterations are not sex‐related. Children treated with cranial irradiation in combination with SMHDMTX and/or ITMTX were at greater risk of developing morphological brain alterations than patients with chemotherapy alone. These alterations are partly correlated with reduced neuropsychological performances and seem to stay with a longer post‐therapeutic interval. Med. Pediatr. Oncol. 28: 387–400, 1997. © 1997 Wiley‐Liss, Inc.

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“…Leukoencephalopathy is usually associated with progressive decline in cognitive functions, behavioral changes, gait abnormalities, and sometimes seizures. Concomitant use of radiotherapy with chemotherapy enhances the process [9]. Because radiotherapy is almost always given in LM in conjunction with other therapeutic modalities, and particularly with CNSdirected chemotherapy, it is difficult to separate its adverse effects from those of the chemotherapy.…”

Section: Complications Of Radiotherapymentioning

confidence: 99%

Toxicity of treatment for neoplastic meningitis

Siegal¹

2003

Curr Oncol Rep

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Neoplastic seeding of the leptomeninges often signifies limited life expectancy. Still, patients are frequently offered aggressive multimodality therapies to palliate symptoms, and, one hopes, to prolong survival. Treatment modalities directed at the central nervous system (CNS) include radiotherapy, intra-cerebrospinal fluid (CSF) chemotherapy, standard systemic chemotherapy, and systemic high-dose chemotherapy. Because many of these modalities are used in combination, it is often difficult to discern which mode is the predominant cause of either acute or delayed complications. This review summarizes the incidence, clinical manifestations, laboratory findings, and pathology related to acute and delayed toxicity of treatment. It describes complications associated with radiotherapy, the use of an intraventricular implanted device (ie, Ommaya device), adverse effects of intra-CSF chemotherapy, and neurotoxicity, either associated with high-dose chemotherapy or manifested as delayed and chronic complications of combined therapies. All CNS-directed therapies are associated with a high rate of complications. The adverse effects of therapy profoundly affect the patient's quality of life, both at the acute phase of treatment and in late and chronic complications after therapy is completed. Intra-CSF chemotherapy is associated with a high rate of acute, reversible adverse effects that sometimes evolve into life-threatening medical conditions. Devastating delayed complications, mainly described as leukoencephalopathy, develop in more than 50% of patients who survive for extended periods and often lead to progressive loss of cognitive capacities. Careful assessment of the benefits and potential adverse reactions to a particular therapy regimen is mandated.

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Computerized tomography scan findings in children with acute lymphocytic leukemia treated with three different methods of central nervous system prophylaxis

Cited by 34 publications

References 18 publications

Diagnosis and Management of Central Nervous System Metastases from Breast Cancer

Diagnosis and Management of Central Nervous System Metastases from Breast Cancer

CNS late effects after ALL therapy in childhood. Part I: Neuroradiological findings in long-term survivors of childhood ALL—an evaluation of the interferences between morphology and neuropsychological performance

Toxicity of treatment for neoplastic meningitis

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