Cranial Irradiation for Pediatric T-lineage Acute Lymphoblastic Leukemia: A Systematic Review.
cooperative groups have heterogeneous approaches to cranial irradiation therapy (CRT)
for T-lineage acute lymphoblastic leukemia (T-ALL). We performed a systematic review of
studies that specified a radiation strategy and reported survival for pediatric T-ALL.
Our analysis included 59 publications reporting 75 treatment groups (patient n=5731).
Over time, average event-free ... read moresurvival (EFS) was higher by 6% per 5 years (p<0.001).
Adjusting for year, EFS differed among studies that used different radiation strategies:
(a) CRT for all patients: (65%, 95% confidence interval, CI: 61% to 68%); (b)
risk-directed CRT (55%, 95% CI: 49% to 62%); (c) CRT for central nervous system (CNS)
positive patients only (61%, 95% CI: 50% to 72%); (d) CRT omitted for all (70%, 95% CI:
60% to 80%). Compared to the reference group (CRT for all), studies that administered
CRT to CNS positive patients only or omitted CRT completely reported similar EFS in a
year-adjusted meta-regression. Intensive asparaginase was associated with higher EFS
after adjustment for year (p=0.003). CRT may not be necessary with current chemotherapy
for T-ALL. However, because these observations are drawn from noncomparative studies,
these associations are susceptible to bias and represent a rather weak evidentiary basis
for drawing conclusions on the comparative effectiveness of alternative CRT
Thesis (M.S.)--Tufts University, 2013.
Submitted to the Dept. of Clinical & Translational Science.
Advisor: Susan Parsons.
Committee: Thomas Trikalinos, and Issa Dahabreh.
Keyword: Medicine.read less