Hill J M, Kornblith A B, Jones D, Freeman A, Holland J F, Glicksman A S, Boyett J M, Lenherr B, Brecher M L, Dubowy R, Kung F, Maurer H, Holland J C
University of Medicine and Dentistry of New Jersey, Newark 07103-2714, USA.
Cancer. 1998 Jan 1;82(1):208-18.
Although previous research has delineated medical, cognitive, and neuropsychologic late effects of central nervous system (CNS) prophylaxis for childhood acute lymphoblastic leukemia (ALL), it has been difficult to draw conclusions about the long term psychosocial sequelae of these treatments due to methodologic problems that led to inconclusive results in past studies. In the current study, the authors examined the long term psychosocial functioning of childhood ALL survivors who had been treated on a Phase III clinical protocol (Cancer and Leukemia Group B [CALGB] 7611) between 1976 and 1979, in which they were randomized to receive either 2400 centigray of cranial radiation (CRT) with intrathecal methotrexate (IT-MTX) or intermediate dose systemic methotrexate (IV-MTX) with IT-MTX.
One hundred ten survivors of childhood ALL (mean age, 20.8 years) treated on CALGB 7611 who were age 14 years or older and disease free for at least 1 year were studied a mean of 14.7 years after their entry on CALGB 7611. In a telephone interview, a psychosocial assessment battery was administered to the patients, consisting of measures that assessed psychologic, sexual, social, and vocational functioning as well as any delayed physical effects.
Survivors who had received CRT + IT-MTX had significantly poorer academic achievement (P = 0.0001), poorer self-images with regard to their bodies (P = 0.001), and greater psychologic distress (P = 0.005).
Cranial radiation used to treat children with ALL has significant long term sequelae in terms of poorer academic achievement and psychosocial functioning. These data add weight to the conclusion that CRT prophylaxis should only be used to treat children who are at high risk of CNS relapse.
尽管先前的研究已经描述了儿童急性淋巴细胞白血病（ALL）中枢神经系统（CNS）预防治疗的医学、认知和神经心理方面的晚期效应，但由于方法学问题导致过去的研究结果不确定，因此很难就这些治疗的长期心理社会后遗症得出结论。在当前的研究中，作者调查了1976年至1979年间按照III期临床方案（癌症与白血病B组[CALGB]7611）接受治疗的儿童ALL幸存者的长期心理社会功能，在该方案中，他们被随机分配接受2400厘戈瑞的颅脑放疗（CRT）联合鞘内甲氨蝶呤（IT-MTX）或中等剂量全身甲氨蝶呤（IV-MTX）联合IT-MTX。
对110名在CALGB 7611研究中接受治疗的儿童ALL幸存者（平均年龄20.8岁）进行研究，这些幸存者年龄在14岁及以上且无病至少1年，自进入CALGB 7611研究起平均随访14.7年。通过电话访谈，对患者进行心理社会评估，评估内容包括心理、性、社会和职业功能以及任何延迟的身体影响。
接受CRT + IT-MTX治疗的幸存者学业成绩显著较差（P = 0.0001），对自身身体的自我形象较差（P = 0.001），心理困扰更大（P = 0.005）。
用于治疗儿童ALL的颅脑放疗在学业成绩较差和心理社会功能方面有显著的长期后遗症。这些数据进一步支持了CRT预防仅应用于治疗CNS复发高危儿童的结论。
