title: Comprehensive craniospinal radiation for controlling central nervous system leukemia.
abstract: OBJECTIVE
  To determine the benefit of radiation therapy (RT) in resolution of neurologic symptoms and deficits and whether the type of RT fields influences central nervous system (CNS) control in adults with CNS leukemia.
  
  
  METHODS
  A total of 163 adults from 1996 to 2012 were retrospectively analyzed. Potential associations between use of radiation and outcome were investigated by univariate and multivariate analysis.
  
  
  RESULTS
  The median survival time was 3.8 months after RT. Common presenting symptoms were headache in 79 patients (49%), cranial nerve VII deficit in 46 (28%), and cranial nerve II deficit in 44 (27%). RT was delivered to the base of skull in 48 patients (29%), to the whole brain (WB) in 67 (41%), and to the craniospinal axis (CS) in 48 (29%). Among 149 patients with a total of 233 deficits, resolution was observed in 34 deficits (15%), improvement in 126 deficits (54%), stability in 34 deficits (15%), and progression in 39 deficits (17%). The 12-month CNS progression-free survival was 77% among those receiving CS/WB and 51% among those receiving base of skull RT (P=.02). On multivariate analysis, patients who did not undergo stem cell transplantation after RT and base of skull RT were associated with worse CNS progression-free survival.
  
  
  CONCLUSIONS
  Improvement or resolution of symptoms occurred in two thirds of deficits after RT. Comprehensive radiation to the WB or CS seems to offer a better outcome, especially in isolated CNS involvement.
authors.affiliation: Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: Gary V
authors.initials: GV
authors.lastname: Walker
authors.affiliation: Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: Ferial
authors.initials: F
authors.lastname: Shihadeh
authors.affiliation: Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: Hagop
authors.initials: H
authors.lastname: Kantarjian
authors.affiliation: Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: Pamela
authors.initials: P
authors.lastname: Allen
authors.affiliation: Department of Stem Cell Transplantation, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: Gabriela
authors.initials: G
authors.lastname: Rondon
authors.affiliation: Department of Stem Cell Transplantation, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: Partow
authors.initials: P
authors.lastname: Kebriaei
authors.affiliation: Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: Susan
authors.initials: S
authors.lastname: O'Brien
authors.affiliation: Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: Aziza
authors.initials: A
authors.lastname: Kedir
authors.affiliation: Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: Mustefa
authors.initials: M
authors.lastname: Said
authors.affiliation: Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: Jonathan D
authors.initials: JD
authors.lastname: Grant
authors.affiliation: Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: Deborah A
authors.initials: DA
authors.lastname: Thomas
authors.affiliation: Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: Paul W
authors.initials: PW
authors.lastname: Gidley
authors.affiliation: Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: Isidora
authors.initials: I
authors.lastname: Arzu
authors.affiliation: Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: Chelsea
authors.initials: C
authors.lastname: Pinnix
authors.affiliation: Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: Valerie
authors.initials: V
authors.lastname: Reed
authors.affiliation: Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas. Electronic address: bdabaja@mdanderson.org.
authors.forename: Bouthaina S
authors.initials: BS
authors.lastname: Dabaja
mesh_terms: D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D016543:Central Nervous System Neoplasms / Q000150:complications / Q000401:mortality / Q000532:radiotherapy*; D003389:Cranial Nerve Diseases / Q000209:etiology / Q000532:radiotherapy*; D061888:Craniospinal Irradiation / Q000379:methods*; D018450:Disease Progression; D018572:Disease-Free Survival; D005155:Facial Nerve Diseases / Q000209:etiology / Q000532:radiotherapy; D005260:Female; D006801:Humans; D007938:Leukemia / Q000150:complications / Q000401:mortality / Q000532:radiotherapy*; D008297:Male; D008875:Middle Aged; D009901:Optic Nerve Diseases / Q000209:etiology / Q000532:radiotherapy; D012189:Retrospective Studies; D033581:Stem Cell Transplantation; D016896:Treatment Outcome; D055815:Young Adult