Brain sarcoma of meningeal origin after cranial irradiation in childhood acute lymphocytic leukemia

1984 ◽  
Vol 61 (4) ◽  
pp. 772-776 ◽  
Author(s):  
Pascal Tiberin ◽  
Esther Maor ◽  
Rina Zaizov ◽  
Ian J. Cohen ◽  
Menachem Hirsch ◽  
...  
Keyword(s):  
Acute Lymphocytic Leukemia ◽  
Childhood Leukemia ◽  
Multimodality Treatment ◽  
Cranial Irradiation ◽  
Lymphocytic Leukemia ◽  
Whole Brain Irradiation ◽  
Content Type ◽  
Brain Irradiation ◽  
Low Dosage

✓ The authors report their experience with an unusual case of intracerebral sarcoma of meningeal cell origin in an 8½-year-old girl. This tumor occurred 6½ years after cranial irradiation at relatively low dosage (2200 rads) had been delivered to the head in the course of a multimodality treatment for acute lymphocytic leukemia. The tumor recurred approximately 10 months after the first surgical intervention. Macroscopic total excision of the recurrent growth followed by whole-brain irradiation (4500 rads) failed to eradicate it completely and local recurrence prompted reoperation 18 months later. This complication of treatment in long-term childhood leukemia survivors is briefly discussed, as well as the pathology of meningeal sarcomas.

Reduction in radiation-induced brain injury by use of pentobarbital or lidocaine protection

1990 ◽  
Vol 72 (5) ◽  
pp. 737-744 ◽  
Author(s):  
Edward H. Oldfield ◽  
Robert Friedman ◽  
Timothy Kinsella ◽  
Ross Moquin ◽  
Jeffrey J. Olson ◽  
...  
Keyword(s):  
Survival Rates ◽  
Cranial Irradiation ◽  
High Dose ◽  
Radiation Toxicity ◽  
Whole Brain Irradiation ◽  
Whole Brain ◽  
Content Type ◽  
Brain Irradiation ◽  
Cns Neoplasms ◽  
Fine Print

✓ To determine if barbiturates would protect brain at high doses of radiation, survival rates in rats that received whole-brain x-irradiation during pentobarbital- or lidocaine-induced anesthesia were compared with those of control animals that received no medication and of animals anesthetized with ketamine. The animals were shielded so that respiratory and digestive tissues would not be damaged by the radiation. Survival rates in rats that received whole-brain irradiation as a single 7500-rad dose under pentobarbital- or lidocaine-induced anesthesia was increased from between from 0% and 20% to between 45% and 69% over the 40 days of observation compared with the other two groups (p < 0.007). Ketamine anesthesia provided no protection. There were no notable differential effects upon non-neural tissues, suggesting that pentobarbital afforded protection through modulation of ambient neural activity during radiation exposure. Neural suppression during high-dose cranial irradiation protects brain from acute and early delayed radiation injury. Further development and application of this knowledge may reduce the incidence of radiation toxicity of the central nervous system (CNS) and may permit the safe use of otherwise “unsafe” doses of radiation in patients with CNS neoplasms.

Whole-brain irradiation and decline in intelligence: the influence of dose and age on IQ score.

1992 ◽  
Vol 10 (9) ◽  
pp. 1390-1396 ◽  
Author(s):  
J H Silber ◽  
J Radcliffe ◽  
V Peckham ◽  
G Perilongo ◽  
P Kishnani ◽  
...  
Keyword(s):  
Multiple Linear Regression Model ◽  
Cranial Irradiation ◽  
Lymphocytic Leukemia ◽  
Whole Brain Irradiation ◽  
Whole Brain ◽  
Iq Testing ◽  
Brain Irradiation ◽  
Significant Difference ◽  
Appropriate Therapy ◽  
The Impact

PURPOSE Decline in intelligence can occur after whole-brain cranial irradiation for childhood malignancy. The purpose of this analysis was to estimate better the impact of dose and age at time of irradiation on IQ decline. PATIENTS AND METHODS A total of 48 children were studied. We combined two previously reported studies that included 15 patients with pediatric acute lymphocytic leukemia (ALL) and 18 pediatric patients with medulloblastoma/posterior fossa primitive neural ectodermal tumors (PNETs) in whom serial IQ tests were administered. Another 15 patients (nine ALL and six PNET) were studied subsequent to these reports. This experience included ALL patients who were treated with whole-brain irradiation at doses of 18 Gy (n = 9) and 24 Gy (n = 15), and PNET patients who were treated with 18 Gy (n = 5), 22 to 24 Gy (n = 2), and 32 to 40 Gy (n = 17). Multiple regression models were constructed to estimate expected IQ score after treatment based on initial IQ score, age at treatment, and dose of whole-brain irradiation. RESULTS Using a multiple linear regression model to correct for initial IQ and age at treatment, patients who received a dose of 36 Gy to the whole brain were estimated to score 8.2 points less on IQ testing than those with 24 Gy (95% confidence interval [CI], 1.8 to 14.6) and 12.3 points less than those who received 18 Gy (95% CI, 2.7 to 21.7). Older age at the time of irradiation resulted in less decline in subsequent IQ score. The predicted IQ decline is 11.9 points less in a 10-year-old patient than in a 3-year-old patient (95% CI, 4.2 to 19.6) for equivalent doses of irradiation. The model to predict IQ accounts for half the total variation in IQ score. There was no significant difference between the coefficients that reflected IQ decrease from radiation dose between subgroups who had ALL versus those with PNET. CONCLUSIONS One can forecast final IQ score based on the initial IQ score, dose of irradiation, and age at time of irradiation. Our findings should aid in the selection of appropriate therapy when whole-brain irradiation is needed.

The Role of the Practitioner in the Care of Children with Acute Leukemia

1983 ◽  
Vol 5 (3) ◽  
pp. 81-87
Author(s):  
Nancy L. Dunn ◽  
Harold M. Maurer
Keyword(s):  
Acute Leukemia ◽  
B Cell ◽  
Childhood Leukemia ◽  
Multimodality Treatment ◽  
Diagnostic Techniques ◽  
Cranial Irradiation ◽  
Lymphocytic Leukemia ◽  
Intrathecal Methotrexate ◽  
Immunologic Assays

The prognosis for a child with acute leukemia has improved dramatically over the past two decades. There are many factors that account for the improved survival rate including: better supportive care, especially for infectious and hematologic complications; sophisticated diagnostic techniques; and more effective multimodality treatment. The purpose of this article is to provide a guide for handling some of the more common questions and problems that may arise in the course of managing the care of a child with leukemia in practice. The classification of leukemia, previously based simply on the morphology of the bone marrow elements, is now determined by a complex array of morphologic, cytochemical, and immunologic characteristics. The determination of cell surface and cytoplasmic markers by immunologic assays now permits the subclassification of acute lymphocytic leukemia, the most common form of childhood leukemia, into T, B, null, and pre-B subtypes (Table 1). The T and B cell subtypes are associated with a poorer prognosis than the null and pre-B cell subtypes and treatment is tailored accordingly. Antileukemic therapy also has undergone change and refinement. The 1950s and 1960s brought many new cytotoxic drugs, first used singly and then in combinations. The end of this era was marked by the discovery of the value of prophylactic CNS treatment, using cranial irradiation and intrathecal methotrexate, in greatly reducing the incidence of meningeal leukemia.

Educational Late Effects in Long-Term Survivors of Childhood Acute Lymphocytic Leukemia

PEDIATRICS ◽  
1988 ◽  
Vol 81 (1) ◽  
pp. 127-133
Author(s):  
Virginia C. Peckham ◽  
Anna T. Meadows ◽  
Nettie Bartel ◽  
Osvaldo Marrero
Keyword(s):  
Parental Support ◽  
Acute Lymphocytic Leukemia ◽  
School Achievement ◽  
Chemotherapeutic Agents ◽  
Lymphocytic Leukemia ◽  
Intrathecal Methotrexate ◽  
And Mathematics ◽  
Long Term Survivors ◽  
Reading And Mathematics

Records of levels of school achievement in long-term survivors of childhood acute lymphocytic leukemia were obtained for 23 children who had received 2,400-rad cranial irradiation and intrathecal methotrexate and standard chemotherapeutic agents 8 to 10 years previously. The children had been evaluated with standardized tests of intelligence at the time of diagnosis and periodically thereafter. Declines in IQ and cognitive dysfunctions have been previously described. School placements, educational histories, attendance records, learning strengths and weaknesses, social/emotional adjustments, and grade level achievements in reading and mathematics as measured by standardized achievement tests are reported here. Children achieved less than the expected levels in both reading and mathematics given both pretreatment and most recent IQ scores. Neither sex nor initial IQ were related to achievement scores. Children experienced difficulty with attention/concentration, memory, sequencing, and comprehension when performing school tasks. Individual children showed different degrees of dysfunction, but results of this study suggest that there are patterns of specific learning disabilities rather than global retardation. A small number of children achieved greater than expected levels, indicating that individualized instruction, tutoring, and parental support may reduce some learning deficits. Early educational intervention is recommended for similarly treated patients.

scholarly journals Immune function at diagnosis in relation to responses to therapy in acute lymphocytic leukemia of childhood

Blood ◽  
1976 ◽  
Vol 47 (6) ◽  
pp. 1011-1021 ◽  
Author(s):  
DG Jose ◽  
H Ekert ◽  
J Colebatch ◽  
K Waters ◽  
F Wilson ◽  
...  
Keyword(s):  
Acute Lymphocytic Leukemia ◽  
Cranial Irradiation ◽  
Prophylactic Cranial Irradiation ◽  
Lymphocytic Leukemia ◽  
Lymphoid Cells ◽  
Multiple Drug ◽  
First Remission ◽  
Immune Capacity ◽  
Multiple Drug Therapy

Abstract Tests of immune capacity were performed on blood from 49 children with newly diagnosed, untreated acute lymphocytic leukemia, and relation to prognosis was determined. Patients were treated with multiple-drug therapy and prophylactic cranial irradiation. Median follow-up time was 16 mo (range 10--37 mo). Principal unfavorable findings at diagnosis were absolute numbers of T lymphoid cells outside the range 850-- 2500/mul blood, absence of whole blood responses to phytohemagglutinin in vitro, a low titer of complexed antibody, and the presence in serum of free leukemic blast cell membrane antigen. Fourteen patients showed two or more unfavorable findings at diagnosis. Eleven of these have died. Four of the remaining 35 patients have died. A shorter duration of first remission was found among patients with abnormal numbers of T cells at diagnosis. The findings suggest that the immunologic capacity of the patient at diagnosis is an important determinant in responses to therapy.

scholarly journals Efficacy of high-dose methotrexate in childhood acute lymphocytic leukemia: analysis by contemporary risk classifications

Blood ◽  
1988 ◽  
Vol 71 (4) ◽  
pp. 866-869 ◽  
Author(s):  
M Abromowitch ◽  
J Ochs ◽  
CH Pui ◽  
D Fairclough ◽  
SB Murphy ◽  
...  
Keyword(s):  
Acute Lymphocytic Leukemia ◽  
Leukemic Cell ◽  
Risk Groups ◽  
Cranial Irradiation ◽  
Lymphocytic Leukemia ◽  
High Dose ◽  
Average Risk ◽  
High Dose Methotrexate ◽  
Dose Methotrexate ◽  
Table Analysis

Abstract High-dose methotrexate (HDMTX) added to a basic regimen of chemotherapy proved superior to cranial irradiation and sequentially administered drug pairs (RTSC) in prolonging complete remissions in children with “standard-risk” acute lymphocytic leukemia. To extend this result to more contemporary risk groups, we reclassified the patients according to methods of the Pediatric Oncology Group (POG), the Childrens Cancer Study Group (CCG), the Rome workshop, and St Jude Total Therapy Study XI. By life table analysis, 70% to 78% of patients with a favorable prognosis would remain in continuous complete remission (CCR) at 4 years if treated with HDMTX. Uniformly lower CCR rates could be expected with RTSC, especially in St Jude better-risk patients. HDMTX also would show greater efficacy than RTSC in the CCG average-risk and POG poor-risk groups, but the results appear inferior to those being achieved with intensified regimens for high-risk leukemia. Although both therapies would provide adequate CNS prophylaxis in favorable-risk groups, RTSC would offer greater protection in patients classified as being in a worse-risk group by St Jude criteria. We conclude that HDMTX- based therapy, as described in this report, would be most effective in patients with a presenting leukocyte count of less than 25 x 10(9)/L, of the white race, aged 2 to 10 years, and having leukemic cell hyperdiploidy without translocations.

B cell acute lymphocytic leukemia in adults. Clinical, morphologic, and immunologic findings.

1986 ◽  
Vol 4 (5) ◽  
pp. 737-743 ◽  
Author(s):  
P S Gill ◽  
P R Meyer ◽  
Z Pavlova ◽  
A M Levine
Keyword(s):  
B Cell ◽  
Acute Lymphocytic Leukemia ◽  
Disease Free Survival ◽  
Lymphocytic Leukemia ◽  
Cell Phenotype ◽  
History Of ◽  
Acquired Immunodeficiency ◽  
Immunologic Marker ◽  
Immunodeficiency Syndrome

Acute lymphocytic leukemia (ALL) is a heterogeneous group of disorders, clinically, immunologically, and pathologically. ALL of a B cell phenotype (B-ALL) is the least common. We have studied ten adult patients with B-ALL, none of whom had a tumor mass. The median age was 56 years (range, 30 to 90). A history of an altered immune state was noted in four cases: a distant history of Hashimoto's thyroiditis in one, pregnancy in one, and acquired immunodeficiency syndrome in two. Two patients presented with CNS involvement, and in two additional patients CNS leukemia developed during the course of disease. By the French-American-British (FAB) classification system, L3 leukemic morphology was present in nine, whereas L2 was present in one. Circulating leukemic blasts varied from less than 500/dL to greater than 15,000/dL. Eight patients were thrombocytopenic, and eight were anemic at presentation. Immunologic marker studies on leukemic blasts revealed monoclonal kappa light chain marking in nine and monoclonal lambda in one. Following chemotherapy, complete remission was achieved in three patients, two of whom experienced relapse within 9 months. The median survival for the group was 3 months, and only one patient experienced long-term, disease-free survival. We conclude that B-ALL in the adult presents with the classic L3 morphologic picture in the majority and is associated with extremely short survival.

Cranial irradiation and lymphocyte subpopulations in acute lymphocytic leukemia

1978 ◽  
Vol 92 (5) ◽  
pp. 785-786 ◽  
Author(s):  
Kunio Kishida ◽  
Sumio Miyazaki ◽  
Hiromichi Take ◽  
Takeo Fujimoto ◽  
Hiroyuki Shin ◽  
...  
Keyword(s):  
Acute Lymphocytic Leukemia ◽  
Cranial Irradiation ◽  
Lymphocyte Subpopulations ◽  
Lymphocytic Leukemia
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