Evaluation of the Late Effects of CNS Prophylactic Treatment in Childhood Acute Lymphoblastic Leukemia (ALL) Using Magne
The aim of the study was to evaluate the late changes seen in Magnetic Resonance Spectroscopy (MRS) of the brain in Acute Lymphoblastic Leukemia (ALL) survivors to assess neurotoxicity following prophylactic treatment with cranial irradiation (CRT) and/or
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stract Purpose The aim of the study was to evaluate the late changes seen in Magnetic Resonance Spectroscopy (MRS) of the brain in Acute Lymphoblastic Leukemia (ALL) survivors to assess neurotoxicity following prophylactic treatment with cranial irradiation (CRT) and/or intrathecal (ITMTX) and systemic MTX. Materials and Methods The study was performed on two groups of patients. The first group consisted of 30 children who received CRT and ITMTX, and the second group was comprised of 15 children treated only with ITMTX. All patients were ALL survivors treated between 1994 and 2002. Radiotherapy was performed using two opposite fields for a total dose of 18 Gy. The children were examined from 6 to 12 years after treatment. All children underwent a physical and neurological examination and MRI/MRS studies. 1H-MR spectra were acquired from frontal and occipital regions of the brain. Mean values and standard deviations were calculated for following metabolite ratios: NAA/Cr, Cho/Cr, Cho/NAA, and mI/Cr. Results Three of the 45 children (11%) presented with white matter changes upon MRI examination. All children with MRI abnormalities received CRT. In 13 (31%) children, changes in 1H-MRS metabolite ratios were seen. We observed decreased NAA/Cr and Cho/Cr ratios. MR spectroscopy showed a significant reduction (P < .05) of the mean NAA/Cr ratio in children given CRT. Conclusion MRS is a sensitive detector of late metabolic changes after prophylactic treatment for ALL in childhood. It is able to detect metabolic effects of treatment in patients even when no morphologic changes are visible upon MRI. K. Ficek (*) Department of Radiotherapy, Center of Oncology Maria Skłodowska Curie Memorial Institute-Branch, Wybrzeże Armii Krajowej 14, 44-101, Gliwice, Poland e-mail: [email protected] D.S. Jakimczyk Department of Paediatic Oncology Organization Medical University , Center of Oncology Maria Skłodowska Curie Memorial InstituteBranch, 3 Maja 15, 41-800 zabrze
Keywords Brain injury • late effects after cancer therapy • MRS • childhood leukemia
Introduction Prophylactic central nervous system therapy is an essential component of the treatment for childhood acute lymphoblastic leukemia (1). Cranial irradiation (CRT) and intrathecal methotrexate (ITMTX) have been introduced as prophylactic treatments that reduce the CNS relapse rate. It is well documented that radiotherapy and chemotherapy, either alone or in combination, may lead to structural and functional changes in the central nervous system. The children who were irradiated develop long-term neurocognitive sequelae affecting intellectual functions and psychological status (2,3). Imaging changes revealed upon CT or MRI after prophylactic treatment are useful in the detection of CNS complications, but neurointellectual disturbances have been observed without any imaging changes in some cases (4,5). Proton Magnetic Resonance Spectroscopy (MRS) is a safe, non-invasive diagnostic method that may provide more information concerning neurotoxicity after prophylactic treatm
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