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. 2014 Dec 1;90(5):1119-25.
doi: 10.1016/j.ijrobp.2014.08.004.

Comprehensive craniospinal radiation for controlling central nervous system leukemia

Gary V Walker  1 , Ferial Shihadeh  1 , Hagop Kantarjian  2 , Pamela Allen  1 , Gabriela Rondon  3 , Partow Kebriaei  3 , Susan O'Brien  2 , Aziza Kedir  1 , Mustefa Said  1 , Jonathan D Grant  1 , Deborah A Thomas  2 , Paul W Gidley  4 , Isidora Arzu  1 , Chelsea Pinnix  1 , Valerie Reed  1 , Bouthaina S Dabaja  5
Affiliations

Comprehensive craniospinal radiation for controlling central nervous system leukemia

Gary V Walker et al. Int J Radiat Oncol Biol Phys. .

Abstract

Purpose: To determine the benefit of radiation therapy (RT) in resolution of neurologic symptoms and deficits and whether the type of RT fields influences central nervous system (CNS) control in adults with CNS leukemia.

Methods and materials: A total of 163 adults from 1996 to 2012 were retrospectively analyzed. Potential associations between use of radiation and outcome were investigated by univariate and multivariate analysis.

Results: The median survival time was 3.8 months after RT. Common presenting symptoms were headache in 79 patients (49%), cranial nerve VII deficit in 46 (28%), and cranial nerve II deficit in 44 (27%). RT was delivered to the base of skull in 48 patients (29%), to the whole brain (WB) in 67 (41%), and to the craniospinal axis (CS) in 48 (29%). Among 149 patients with a total of 233 deficits, resolution was observed in 34 deficits (15%), improvement in 126 deficits (54%), stability in 34 deficits (15%), and progression in 39 deficits (17%). The 12-month CNS progression-free survival was 77% among those receiving CS/WB and 51% among those receiving base of skull RT (P=.02). On multivariate analysis, patients who did not undergo stem cell transplantation after RT and base of skull RT were associated with worse CNS progression-free survival.

Conclusions: Improvement or resolution of symptoms occurred in two thirds of deficits after RT. Comprehensive radiation to the WB or CS seems to offer a better outcome, especially in isolated CNS involvement.

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Conflict of interest statement

Conflict of interest: none.

Figures

Fig. 1
Fig. 1
Common radiation fields to treat central nervous system leukemia include base of skull (a), whole brain (b), or entire craniospinal axis (c) with proton (left) or photon (right).
Fig. 2
Fig. 2
Kaplan-Meier progression-free survival curves comparing patients receiving base of skull radiation therapy with those treated by craniospinal or whole brain radiation therapy among all patients (a) and stratified by bone marrow status (b). BM = bone marrow; BOS = base of skull radiation therapy; CNS = central nervous system; CSI = craniospinal radiation therapy; WBRT = whole brain radiation therapy.
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