PMID- 22971657
OWN - NLM
STAT- MEDLINE
DCOM- 20130404
LR  - 20220408
VI  - 16
IP  - 2
DP  - 2012 Apr-Jun
TI  - [Late sequelae of central nervous system prophylaxis in children with acute 
      lymphoblastic leukemia: high doses of intravenous methotrexate versus 
      radiotherapy of the central nervous system--review of literature].
PG  - 128-37
AB  - Acute lymphoblastic leukemia is the most common malignancy in children. All 
      current therapy regimens used in the treatment of childhood acute lymphoblastic 
      leukemia include prophylaxis of the central nervous system. Initially it was 
      thought that the best way of central nervous system prophylaxis is radiotherapy. 
      But despite its effectiveness this method, may cause late sequelae and 
      complications. In the programme currently used in Poland to treat acute 
      lymphoblastic leukemia, prophylactic radiotherapy has been reduced by 50% (12 Gy) 
      and is used only in patients stratified into the high risk group and in patients 
      diagnosed as T-cell ALL (T-ALL). Complementary to radiotherapy, intrathecal 
      methotrexate is given alone or in combination with cytarabine and hydrocortisone 
      is given, as well as systemic chemotherapy with intravenous methotrexate is 
      administered in high or medium doses (depending on risk groups and leukemia 
      immunophenotype). Recent studies have shown that high dose irradiation of the 
      central nervous system impairs cognitive development causing memory loss, 
      visuomotor coordination impairment, attention disorders and reduction in the 
      intelligence quotient. It has been proved that the degree of cognitive impairment 
      depends on the radiation dose directed to the medial temporal lobe structures, 
      particularly in the hippocampus and the surrounding cortex. Also, methotrexate 
      used intravenously in high doses, interferes with the metabolism of folic acid 
      which is necessary for normal development and the optimal functioning of neurons 
      in the central nervous system. It has been proved that patients who have been 
      treated with high doses of methotrexate are characterized by reduced memory 
      skills and a lower intelligence quotient. The literature data concerning long 
      term neuroanatomical abnormalities and neuropsychological deficits are ambiguous, 
      and there is still no data concerning current methods of central nervous system 
      prophylaxis with low doses of irradiation in combination with high doses of 
      intravenous methotrexate.
FAU - Zajac-Spychala, Olga
AU  - Zajac-Spychala O
AD  - Klinika Onkologii, Hematologii i Transplantologii Pediatrycznej UM w Poznaniu, 
      ul. Szpitalna 27/33, 60-572 Poznan, Poland. olga_zajac@wp.pl
FAU - Wachowiak, Jacek
AU  - Wachowiak J
LA  - pol
PT  - Comparative Study
PT  - English Abstract
PT  - Journal Article
PT  - Review
TT  - Odlegle nastepstwa leczenia zapobiegajacego rozwojowi naciekow bialaczkowych w 
      osrodkowym ukladzie nerwowym u dzieci z ostra bialaczka limfoblastyczna: wysokie 
      dozylne dawki metotreksatu versus napromienienie osrodkowego ukladu 
      nerwowego--przeglad pismiennictwa.
PL  - Poland
TA  - Med Wieku Rozwoj
JT  - Medycyna wieku rozwojowego
JID - 100928610
RN  - 0 (Antimetabolites, Antineoplastic)
RN  - 04079A1RDZ (Cytarabine)
RN  - WI4X0X7BPJ (Hydrocortisone)
RN  - YL5FZ2Y5U1 (Methotrexate)
SB  - IM
MH  - Antimetabolites, Antineoplastic/administration & dosage
MH  - Antineoplastic Combined Chemotherapy Protocols/*therapeutic use
MH  - Attention/radiation effects
MH  - Brain/*radiation effects
MH  - Central Nervous System Neoplasms/prevention & control
MH  - Chemoradiotherapy/adverse effects
MH  - Child
MH  - Cognition Disorders/*etiology
MH  - Cranial Irradiation/*adverse effects
MH  - Cytarabine/administration & dosage
MH  - Humans
MH  - Hydrocortisone/administration & dosage
MH  - Injections, Intravenous
MH  - Memory Disorders/etiology
MH  - Methotrexate/*administration & dosage
MH  - Precursor Cell Lymphoblastic Leukemia-Lymphoma/*drug therapy/*radiotherapy
MH  - Psychomotor Performance/radiation effects
MH  - Radiotherapy Dosage
EDAT- 2012/09/14 06:00
MHDA- 2013/04/05 06:00
CRDT- 2012/09/14 06:00
PHST- 2012/09/14 06:00 [entrez]
PHST- 2012/09/14 06:00 [pubmed]
PHST- 2013/04/05 06:00 [medline]
PST - ppublish
SO  - Med Wieku Rozwoj. 2012 Apr-Jun;16(2):128-37.