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February 1995

Neuropsychological Effects of Cranial Irradiation in Young Children With Acute Lymphoblastic Leukemia 9 Months After Diagnosis

Author Affiliations

From the Department of Psychology and Human Development, Peabody College of Vanderbilt University, Nashville, Tenn (DrMacLean); the Department of Hematology-Oncology, Children's Hospital Medical Center, University of Cincinnati (Ohio) (Dr Noll); the Department of Pediatrics, University of Iowa, Iowa City (Dr Stehbens); the Department of Pediatrics, University of California-Los Angeles (Dr Kaleita); the Department of Pediatric Psychology, University of Michigan, Ann Arbor (Dr Schwartz); the Department of Psychiatry, University of North Carolina-Chapel Hill (Dr Whitt); the Department of Psychology, Primary Children's Medical Center, University of Utah, Salt Lake City (Dr Cantor); the Department of Pediatric Hematology-Oncology, Butterworth Hospital, Grand Rapids, Mich (Ms Waskerwitz); the Department of Pediatric Hematology-Oncology, Ohio State University, Columbus (Dr Ruymann); the Department of Radiology, Case Western Reserve University, Cleveland, Ohio (Dr Novak); the Department of Neuropsychology, University of Wisconsin, Madison (Dr Woodard); and the Department of Pediatrics, University of Southern California School of Medicine, Pasadena (Dr Hammond).

Arch Neurol. 1995;52(2):156-160. doi:10.1001/archneur.1995.00540260060017

Study Objective:  To determine the effects of cranial irradiation on neuropsychological test performance evident 9 months after diagnosis.

Design:  A companion study to a randomized clinical trial (CCG-105).

Setting:  Institutions participating in Childrens Cancer Group cooperative treatment trials.

Patients:  Seventy-four children aged 3.0 to 6.5 years with average-risk acute lymphoblastic leukemia. Children with central nervous system leukemia at the time of diagnosis, preexisting mental retardation, or Down's syndrome or for whom English was not the primary language were not eligible for study.

Interventions:  Children were randomized to receive treatment with one of four systemic chemotherapy regimens and either intrathecal methotrexate sodium during induction and consolidation plus 18 Gy of cranial irradiation or intrathecal methotrexate during induction, consolidation, and maintenance as central nervous system prophylaxis.

Measurement and Results:  The groups were comparable with regard to chronologic age, sex, and family socioeconomic status. Children who received cranial irradiation plus intrathecal methotrexate scored significantly lower on the McCarthy Motor Scale (P<.05) and the Token Test (P<.05) than children who received intrathecal methotrexate alone. The groups did not differ significantly on the McCarthy General Cognitive Index, Developmental Test of Visual Motor Integration, or Peabody Picture Vocabulary Test—Revised.

Conclusions:  Findings suggest that the combined effects of cranial irradiation and intrathecal methotrexate therapy on neuropsychological performance may be evident in young children as early as 9 months after diagnosis. Follow-up assessment of these children will reveal whether these effects remain constant, intensify, or resolve.

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