title: Immediate treatment effects of high-dose methotrexate and cranial irradiation on neuropsychological functions of children treated for acute lymphoblastic leukemia at a regional cancer center.
abstract: BACKGROUND
  Overall cure rates for pediatric acute lymphoblastic leukemia (ALL) have improved; however, the neuropsychological sequelae of ALL treatment have not been adequately documented in India.
  
  
  OBJECTIVE
  The present study assesses the immediate effects of ALL treatment on neuropsychological functioning, at the Regional Cancer Center in Chennai, South India.
  
  
  METHODS
  Newly diagnosed with ALL patients (n = 24) (aged 6-15 years; 13M:11F) registered between March 2008 and February 2009 were included. Patients who had received high-dose methotrexate (HD-MTX) and cranial radiotherapy (CRT) as part of their treatment were enrolled for the study. Neurocognitive assessments were done to assess various functions such as performance intelligence, visuo-perception, visuo-spatial, perceptual organization, processing speed, planning, working memory, and immediate verbal memory (IVM) (Malin's intelligence scale); verbal fluency (ideation fluency test) and verbal attention (vigilance test). Three assessments were done during induction (baseline), after re-induction phase (second) and during the maintenance phase (third).
  
  
  RESULTS
  The patients performed significantly worse in the third assessment (mean duration from diagnosis 17.48 months) on performance intelligence quotient (PIQ), visuo-perception, visuo-spatial, processing speed, planning, IVM, verbal attention, and verbal fluency (P < 0.05), there were no significant changes observed in visuo-perceptual organization and working memory (P > 0.05). Significant difference was observed between age groups 6 and 10 (41.7%) and 11-15 years (58.3%) in perceptual organization, verbal fluency, and verbal attention (P < 0.05) and no gender difference was observed across the three assessments (P > 0.05).
  
  
  CONCLUSIONS
  Combining HD MTX and CRT had an immediate effect on neuropsychological sequelae among the children with ALL, however, long-term evaluation is recommended to study the long-term effects.
authors.affiliation: Department of Psycho-Oncology, Cancer Institute (WIA), Chennai, India.
authors.forename: Sundaramoorthy
authors.initials: S
authors.lastname: Chidambaram
authors.affiliation: GVN Cancer Hospital, Trichy, Tamil Nadu, India.
authors.forename: Arun
authors.initials: A
authors.lastname: Seshachalam
authors.affiliation: Department of Psycho-Oncology, Cancer Institute (WIA), Chennai, India.
authors.forename: Vidhubala
authors.initials: V
authors.lastname: Elangovan
authors.affiliation: Department of Medical Oncology, Cancer Institute (WIA), Chennai, India.
authors.forename: Rejiv
authors.initials: R
authors.lastname: Rajendranath
keywords: Acute lymphoblastic leukemia; central nervous system prophylaxis; chemotherapy; cranial radiation; neuro-cognitive functions