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In the past 10 to IS years there has been dramatic improvement in the survival of children with acute lymphoblastic leukemia. At the present time, over 50% of children with this disease will be alive and free of their disease at least 5 years from the time of their initial diagnosis. Although a number of factors have contributed to this improvement, perhaps none has been as important as the institution of central nervous system preventive therapy (eNS prophylaxis). However, despite the efficacy of eNS prophylaxis, the prevention and treatment of central nervous system leukemia continues to pose a formidable clinical challenge to the pediatric oncologist. Although successful in most cases, eNS preventive therapy remains ineffective for a small but significant subset of patients at high risk for developing eNS disease. Moreover, it has become increasingly evident that some methods of eNS preventive therapy are associated with long-term, adverse eNS sequelae. Thus, considerable controversy exists regarding the optimal method of eNS prophylaxis. Treatment of the patient who develops overt meningeal leukemia has not been as successful and continues to pose a major clinical challenge. Despite the ability of intrathecal chemotherapy and/or radiation therapy to induce eNS remission, most patients suffer subsequent relapse and ultimate survival is usually signifi cantly compromised. It is evident that newer approaches to treatment for this patient group must be identified before major improvement for this patient group is likely to occur.
Table des matières
1. The Pathology of Central Nervous System Leukemia.- 2. Radiation Therapy Methods for Central Nervous System 'Prophylaxis' in the Management of Childhood Leukemias.- 3. Central Nervous System Prophylaxis for Therapy of Acute Lymphocytic Leukemia.- 4. Reduction in Central Nervous System Leukemia with a Pharmaco-kinetically derived Intrathecal-Methotrexate Dosage Regimen.- 5. Central Nervous System Prophylaxis with Intermittent Intrathecal Methotrexate and Fractional Radiation in Childhood Acute Lymphoblastic Leukemia.- 6. Intermittent Intrathecal Methotrexate and Fractional Radiation plus Chemotherapy in Childhood Lymphoblastic Leukemia.- 7. Prophylaxis of Central Nervous System Leukaemia: British Experience, 1970-80.- 8. The Norwegian Methotrexate Study in Childhood Acute Lymphocytic Leukemia.- 9. Therapy Related Central Nervous System Diseases in Children with Acute Lymphocytic Leukemia.- 10. Neurotoxic Complications of CNS Prophylaxis in Childhood Leukaemia.- 11. Evaluation of Adverse Sequelae of Central Nervous System Prophylaxis in Acute Lymphoblastic Leukemia.- 12. Adverse Sequelae of Central Nervous System Prophylaxis in Acute Lymphoblastic Leukemia.- 13. Treatment of Overt CNS Leukaemia.- 14. Radiation Therapy Methods for the Treatment of Central Nervous System Leukemia.- 15. Treatment of Meningeal Leukemia: Investigation of New Approaches with Conventional Agents.
