Cranial Irradiation for Pediatric T-lineage Acute Lymphoblastic Leukemia: A Systematic Review.
Kelly, Michael.
2013
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Abstract: Pediatric 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 sur... read morevival (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 strategies.
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 - ID:
- 5t34sw91g
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