LLA No Necesita Irradiacion Cerebral
1
705 Newsdesk Results from a US study show that cranial irradiation can be avoided in children with acute lymphoblastic leukaemia (ALL). By use of a better method of risk classification, together with intensive intrathecal chemo- therapy for high-risk patients and dexamethasone for post-remission therapy, Ching-Hon Pui and collea- gues at St Jude Children’s Research Hospital, Memphis, TN, USA, have been able to limit the use of cranial irradiation to 12% of patients treated for ALL (Blood 2004; 104: 2690–96). This result compares with 22% of patients given radiotherapy in a prev- ious study. The study involved 247 children younger than 18 years with newly diagnosed ALL. 117 children were classified as low risk (1–9 years with a leucocyte count of <5010 9 /L or a DNA index of >1·16) and 130 as high risk. Cranial irradiation was given only to patients with T-cell ALL and with a leucocyte count of 10010 9 /L or over, or a CNS-3 status (ie, five or more blast cells in an atraumatic CNS sample or presence of cranial-nerve palsy). The study was designed to reduce risk of CNS relapse, use of cranial irradiation, and late complications such as second cancers and neuro- cognitive deficits. “The ability to omit cranial irradiation, while still achieving a high cure rate, would be an important breakthrough”, says Pui. “We chose dexamethasone because there is evidence that it is superior to prednisone and pred- nisolone, especially in control of CNS disease”, he explains. “We also broadened our risk classification to include more lower-risk children in post-remission treatment.” More importantly, says Pui, “it is apparent that patients with any leukaemic cells in their cerebrospinal fluid at diagnosis—even if these were introduced iatrogenically during traumatic lumbar puncture—are at higher risk of CNS relapse. Patients with this feature received more intensive intrathecal therapy, and this approach might also have improved our CNS control”. “No CNS-directed therapy is com- pletely safe, but cranial irradiation has the most late effects”, says David Webb (Great Ormond Street Hospital, London, UK). “This paper builds upon what various other groups have been saying—ie, that cranial irradiation has largely had its day, except for children with CNS leukaemia.” Overall event-free survival (81% at 5 years) and CNS relapse rate (3%) were very good, Webb adds. “The St Jude team has made huge contributions to the advance of know- ledge of childhood leukaemia”, says Tim Eden (University of Manchester, UK). “The big challenges now facing us are to find out why patients otherwise defined as being low risk with conventional techniques still relapse and how we can make therapy applicable worldwide.” Dorothy Bonn No need for cranial irradiation in acute lymphoblastic leukaemia Results of a new phase II trial have shown a weekly regimen of paclitaxel and carboplatin to be an effective treatment for patients with advanced ovarian cancer. Delegates at the 7th International Conference of Anticancer Research (Corfu, Greece; Oct 25–30, 2004) heard researchers from the Ovarian Cancer Study Group of the North-Eastern German Society for Gynaecologic Oncology (NOGGO) explain that a dose-dense regimen was just as effective as, and better tolerated than, the usual three-weekly regimen. Although the outlook for patients with ovarian cancer is poor, most will respond to firstline combination chemotherapy consisting of a platinum compound and a taxol. However, neurological and haematological toxic effects are common and can be dose- limiting. Consequently, these factors often negatively affect patients’ quality of life. In a previous phase I trial, NOGGO found that patients with advanced ovarian cancer could tolerate weekly doses of paclitaxel and carbo- platin (Gynecol Oncol 2002; 85: 321–326). “We then agreed that it would be appropriate to evaluate this dose-dense regimen in a phase II trial", says Oumar Camara, University of Jena, Germany. The study enrolled a total of 134 patients with advanced ovarian cancer (FIGO stage IIb–IV). Weekly paclitaxel and carboplatin were administered in three blocks; an initial dose of 100 mg/m 2 paclitaxel had been defined in the earlier phase I trial. Two-thirds of the patients completed the full treatment plan, and in 75% of the evaluable patients, concentrations of the ovarian-cancer marker CA125 decreased after therapy. The research- ers found the treatment was well tolerated, with fewer serious side- effects than would have been expected in patients given the standard regimen. Furthermore, incidence of alopecia, diarrhoea, and changes in nail morphology were rare. “Our patients’ median post- diagnosis survival time of 43 months after a median 24-month follow-up interval was well within the range of published successful phase III trials, and we have concluded that weekly taxol can be safely combined with weekly carboplatin”, says Camara. “We now urgently need a phase III trial comparing the dose-dense [regimen] with standard treatment.” Clare Sansom Dose-dense therapy shows promise in ovarian cancer Platinum crystals make up valuable treatment. Oncology Vol 5 December 2004 http://oncology.thelancet.com Rights were not granted to include this image in electronic media. Please refer to the printed journal.
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LLA no necesita RT
Transcript of LLA No Necesita Irradiacion Cerebral
-
705
Newsdesk
Results from a US study show thatcranial irradiation can be avoided inchildren with acute lymphoblasticleukaemia (ALL). By use of a bettermethod of risk classification, togetherwith intensive intrathecal chemo-therapy for high-risk patients anddexamethasone for post-remissiontherapy, Ching-Hon Pui and collea-gues at St Jude Childrens ResearchHospital, Memphis, TN, USA, havebeen able to limit the use of cranialirradiation to 12% of patients treatedfor ALL (Blood 2004; 104: 269096).This result compares with 22% ofpatients given radiotherapy in a prev-ious study.
The study involved 247 childrenyounger than 18 years with newlydiagnosed ALL. 117 children wereclassified as low risk (19 years with aleucocyte count of 116) and 130 as highrisk. Cranial irradiation was givenonly to patients with T-cell ALL andwith a leucocyte count of 100109/Lor over, or a CNS-3 status (ie, five or
more blast cells in an atraumatic CNSsample or presence of cranial-nervepalsy).
The study was designed to reducerisk of CNS relapse, use of cranialirradiation, and late complicationssuch as second cancers and neuro-cognitive deficits. The ability to omit cranial irradiation, while stillachieving a high cure rate, would bean important breakthrough, saysPui. We chose dexamethasonebecause there is evidence that it issuperior to prednisone and pred-nisolone, especially in control of CNSdisease, he explains. We alsobroadened our risk classification toinclude more lower-risk children inpost-remission treatment. Moreimportantly, says Pui, it is apparentthat patients with any leukaemic cellsin their cerebrospinal fluid atdiagnosiseven if these wereintroduced iatrogenically duringtraumatic lumbar punctureare athigher risk of CNS relapse. Patientswith this feature received more
intensive intrathecal therapy, and thisapproach might also have improvedour CNS control.
No CNS-directed therapy is com-pletely safe, but cranial irradiation hasthe most late effects, says DavidWebb (Great Ormond StreetHospital, London, UK). This paperbuilds upon what various othergroups have been sayingie, thatcranial irradiation has largely had itsday, except for children with CNSleukaemia. Overall event-freesurvival (81% at 5 years) and CNSrelapse rate (3%) were very good,Webb adds.
The St Jude team has made hugecontributions to the advance of know-ledge of childhood leukaemia, saysTim Eden (University of Manchester,UK). The big challenges now facingus are to find out why patientsotherwise defined as being low riskwith conventional techniques stillrelapse and how we can make therapyapplicable worldwide.Dorothy Bonn
No need for cranial irradiation in acute lymphoblastic leukaemia
Results of a new phase II trial haveshown a weekly regimen of paclitaxeland carboplatin to be an effectivetreatment for patients with advancedovarian cancer. Delegates at the 7thInternational Conference of AnticancerResearch (Corfu, Greece; Oct 2530,2004) heard researchers from theOvarian Cancer Study Group of theNorth-Eastern German Society forGynaecologic Oncology (NOGGO)explain that a dose-dense regimen wasjust as effective as, and better toleratedthan, the usual three-weekly regimen.
Although the outlook for patientswith ovarian cancer is poor, most willrespond to firstline combinationchemotherapy consisting of a platinumcompound and a taxol. However,neurological and haematological toxiceffects are common and can be dose-limiting. Consequently, these factorsoften negatively affect patients qualityof life.
In a previous phase I trial,NOGGO found that patients with
advanced ovarian cancer could tolerateweekly doses of paclitaxel and carbo-platin (Gynecol Oncol 2002; 85:321326). We then agreed that it
would be appropriate to evaluate thisdose-dense regimen in a phase II trial",says Oumar Camara, University ofJena, Germany.
The study enrolled a total of134 patients with advanced ovariancancer (FIGO stage IIbIV). Weeklypaclitaxel and carboplatin wereadministered in three blocks; an initial
dose of 100 mg/m2 paclitaxel had beendefined in the earlier phase I trial.Two-thirds of the patients completedthe full treatment plan, and in 75% ofthe evaluable patients, concentrationsof the ovarian-cancer marker CA125decreased after therapy. The research-ers found the treatment was welltolerated, with fewer serious side-effects than would have been expectedin patients given the standard regimen.Furthermore, incidence of alopecia,diarrhoea, and changes in nailmorphology were rare.
Our patients median post-diagnosis survival time of 43 monthsafter a median 24-month follow-upinterval was well within the range ofpublished successful phase III trials,and we have concluded that weeklytaxol can be safely combined withweekly carboplatin, says Camara.We now urgently need a phase IIItrial comparing the dose-dense[regimen] with standard treatment.Clare Sansom
Dose-dense therapy shows promise in ovarian cancer
Platinum crystals make up valuable treatment.
Oncology Vol 5 December 2004 http://oncology.thelancet.com
Rights were not grantedto include this image inelectronic media. Please
refer to the printedjournal.
