The CNS Relapse of the Acute Lymphoblastic Leukemia: Radiotherapy Results / 대한치료방사선과학회지

ABSTRACT

PURPOSE: To assess the efficacy of craniospinal radiotherapy in patients with acute lymphoblastic leukemia (ALL) experiencing the CNS relapse. MATERIALS AND METHODS: Thirty ALL patients with relapse in the central nervous system(CNS) were treated with radiotherapy and intrathecal chemotherapy. Age ranged 2 to 46. The number of males and females were all 15. Twenty-two cases were previously treated with presymptomatic radiotherapy to the whole brain. The extent of radiotherapy was the whole brain (18-24 Gy) and the whole spine (12 Gy) in 21 cases but the whole brain only in the 9 cases with poor performance. RESULTS: The complete remission rate in the CNS was 10%. Among the 12 cases(40%) who had secondary relapse, 9 cases had the bone marrow relapse alone, 2 cases had the CNS and bone marrow relapse, 1 case had the CNS relapse alone. Higher CNS remission rate was observed when the initial remission duration was longer than 24 months or radiation was delivered to the whole brain and the whole spine. Survival rate at 2 year was 31.6%. Remission duration in the 10 living patients ranged from 9 to 87 months(median ; 58 months). CONCLUSION: The whole craniospinal area should be included in the radiotherapy port for the effective control of CNS relapse in ALL cases