Five years after central nervous system irradiation of children with leukemia

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Twenty-two children with acute lymphocytic leukemia (ALL) who attained complete remission and received preventive central nervous system (CNS) therapy consisting of 2400 rad cranial irradiation with five doom of intrathecal methotrexate followed by 28–36 months of multiple-agent chemotherapy were uniformly evaluated for potential toxicity upon neuropsychological functioning and somatic growth. Retrospective analysis of CNS signs, symptoms and function as well as head size, height and weight were tabulated at loon of therapy, the following 10 weeks, and at 28–36 months when all treatment was stopped. Sixty months after CNS therapy, a current assessment was performed attempting to identify any resultant neuropsychological aberration and disturbance in growth pattern. Nine of the 22 patients developed nonleukemic pleocytosis or presented headache, backache or leg pain. During the 10 weeks after CNS therapy, 8 of 22 patients developed transitory lethargy or somnolence. During continuation chemotherapy mild cerebro spinal fluid (CSF) pleocytosis was seen in some patents. Two children developed pseudo-tumor cerebri but recovered without sequelae. Neurological examination at 60 months was normal is all patients. Although initial head cicrumference averaged somewhat below normal, growth continued without significant deviation from the normal rate. Linear grow was slower than normal in 12 of the patients, following cessation of therapy only 2 persisted with a slower rhythm of longitudinal growth. Weight pattern was within one standard deviation at 5 years in all but 3 patients. About one-third of patients were rated below average in energy level, motivation, attention span, and concrete-abstract thinking, and one-third to one-ball rated above average in academic interest and approach to problems. We conclude from these results that prevention of CNS leukemia including 2400 rad of cranial irradiation in children with ALL Is effective and destitute of prohibitive toxicity on physical growth and neuropsychlogical competency.