title: Cranial radiation for pediatric T-lineage acute lymphoblastic leukemia: a systematic review and meta-analysis.
abstract: There are heterogeneous approaches to cranial radiation therapy (CRT) for T-lineage acute lymphoblastic leukemia (T-ALL). We performed a systematic review of studies that specified a radiation strategy and reported survival for pediatric T-ALL. Our analysis included 62 publications reporting 78 treatment groups (patient n = 5844). The average event-free survival (EFS) was higher by 6% per 5 years (P < 0.001). Adjusting for year, EFS differed by radiation strategy. Compared to the reference group (CRT for all) which had a year-adjusted EFS of 65% (95% confidence interval, CI: 61-69%) the adjusted EFS was significantly worse (rate difference (RD) = -9%, 95% CI: -15 to -2%) among studies that used a risk-directed approach to CRT (P = 0.004). The adjusted EFS for the other strategies were not significantly different compared to the reference group: CRT for central nervous system positive patients only (RD = -3%, 95% CI: -14 to 7%, P = 0.49); CRT omitted for all patients (RD = 5%, 95% CI: -4 to 15%, P = 0.33). CRT may not be necessary with current chemotherapy for T-ALL. These findings, however, are susceptible to bias and caution should be applied in drawing conclusions on the comparative effectiveness of alternative CRT strategies.
authors.affiliation: The Floating Hospital for Children at Tufts Medical Center, Boston, Massachusetts; Department of Pediatrics, Tufts University School of Medicine, Boston, Massachusetts.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Kelly
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Trikalinos
authors.forename: Issa J
authors.initials: IJ
authors.lastname: Dahabreh
authors.forename: Matthew
authors.initials: M
authors.lastname: Gianferante
authors.forename: Susan K
authors.initials: SK
authors.lastname: Parsons
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D054218:Precursor T-Cell Lymphoblastic Leukemia-Lymphoma / Q000401:mortality* / Q000532:radiotherapy*; D012886:Skull; D015996:Survival Rate