Akademik Veri Yönetim Sistemi
Turk Pediatri Arsivi, cilt.44, sa.2, ss.62-67, 2009 (SCI-Expanded, Scopus, TRDizin)
Aim: The aim of this study is to determine the possible side effects of central nervous system (CNS) prophylactic treatment in childhood leukemia by using cranial imaging techniques. Material and Method: Data collected from records of 90 patients diagnosed as acute lymphoblastic leukemia (ALL) and treated according to BFM-90 or TR-ALL 2000 protocols which used lowered dose of methotrexate , between January 1991 and December 2004. Gender, age at diagnosis, immunophenotype, cranial radiation doses, risk groups, intrathecal treatment modalities, neurological and electroencephalography (EEG) findings, imaging interval and techniques were recorded. These variables were analyzed for their role in cranial lesions. Patiens with CNS leukemia and mature B-cell phenotype were excluded. Results: Ninety patients were enrolled in the study. Sixty three patients had up to 18 Gy cranial radiation, whereas in 27 patients radiation was not utilized. Eleven doses of Intrathecal methotrexate were administered to 77 patients and 13 patients had more intensive regimen. No patients demonstrated cortical atrophy or calcifications. Mild white matter changes (WMC) were observed in eight patients. Only one patient had moderate changes. Eight of the nine patients with WMC had radiotherapy but no significant correlation was found (p>0.05). There were also no significant relation of WMA with gender, age at diagnosis, treatment protocol, risk groups, intrathecal therapy, neurologic symptoms, EEG finding and imaging techniques (p>0.05). Conclusions: Intrathecal treatment does not cause cortical atrophy. White matter changes are not influenced by systemic methotrexate dose but radiotherapy may have an additive effect. Short interval between CNS prophylaxis and imaging can be responsible for the limitation of our study at detecting the late effects of radiotherapy. A new study aiming at investigating the late effects of radiotherapy by performing late imaging studies may be more informative.