title: Long-term brain structural magnetic resonance imaging and cognitive functioning in children treated for acute lymphoblastic leukemia with high-dose methotrexate chemotherapy alone or combined with CNS radiotherapy at reduced total dose to 12 Gy.
abstract: BACKGROUND
  The aim of this study was to assess the long-term side effects of central nervous system prophylaxis (high-dose chemotherapy alone vs chemotherapy and CNS radiotherapy) according to the ALL IC-BFM 2002.
  
  
  METHODS
  Thirty-tree children aged 6.7-19.9 years have been studied. The control group consisted of 12 children newly diagnosed with acute lymphoblastic leukemia. We assessed subcortical gray matter volume using automatic MRI segmentation and cognitive performance to identify differences between two therapeutic schemes and patients prior to treatment.
  
  
  RESULTS
  Patients treated with chemotherapy and CNS radiotherapy had smaller hippocampi than two other subgroups and lower IQ score than patients treated with chemotherapy alone. Both treated groups, whether with chemotherapy only or in combination with CNS radiotherapy, had significantly lower volumes of caudate nucleus and performed significantly worse on measures of verbal fluency in comparison with patients prior to treatment. There were no differences in the mean volumes of total white matter, total gray matter, thalamus, putamen, and amygdala between the studied groups.
  
  
  CONCLUSIONS
  In all children treated according to the ALL IC-BFM 2002 with high-dose chemotherapy, both decreased volume of selected subcortical structures and cognitive impairment was observed, especially in children who received chemotherapy in combination with reduced dose CNS radiotherapy. In all children treated according to the ALL IC-BFM 2002 with high-dose chemotherapy, both decreased volume of selected subcortical structures and cognitive impairment were observed, especially in children who received chemotherapy in combination with CNS radiotherapy.
authors.affiliation: Department of Pediatric Oncology, Hematology and Transplantology, Poznan University of Medical Sciences, Szpitalna Str. 27/33, 60-572, Poznan, Poland. olga_zajac@wp.pl.
authors.forename: Olga
authors.initials: O
authors.lastname: Zając-Spychała
authors.affiliation: Department of Neurology and Cerebrovascular Disorders, Poznan University of Medical Sciences, Poznan, Poland.
authors.forename: Mikołaj A
authors.initials: MA
authors.lastname: Pawlak
authors.affiliation: Department of Neuroradiology, Poznan University of Medical Sciences, Poznan, Poland.
authors.forename: Katarzyna
authors.initials: K
authors.lastname: Karmelita-Katulska
authors.affiliation: Department of Pediatric Oncology, Hematology and Transplantology, Poznan University of Medical Sciences, Szpitalna Str. 27/33, 60-572, Poznan, Poland.
authors.forename: Jakub
authors.initials: J
authors.lastname: Pilarczyk
authors.affiliation: Department of Pediatric Oncology, Hematology and Transplantology, Poznan University of Medical Sciences, Szpitalna Str. 27/33, 60-572, Poznan, Poland.
authors.forename: Katarzyna
authors.initials: K
authors.lastname: Derwich
authors.affiliation: Department of Pediatric Oncology, Hematology and Transplantology, Poznan University of Medical Sciences, Szpitalna Str. 27/33, 60-572, Poznan, Poland.
authors.forename: Jacek
authors.initials: J
authors.lastname: Wachowiak
mesh_terms: D000293:Adolescent; D000964:Antimetabolites, Antineoplastic / Q000627:therapeutic use*; D002648:Child; D003072:Cognition Disorders / Q000209:etiology*; D003131:Combined Modality Therapy; D016371:Cranial Irradiation / Q000379:methods*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008727:Methotrexate / Q000627:therapeutic use*; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000000981:diagnostic imaging* / Q000188:drug therapy* / Q000532:radiotherapy*; D011879:Radiotherapy Dosage; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000964:Antimetabolites, Antineoplastic; D008727:Methotrexate
keywords: Acute lymphoblastic leukemia; Brain; CNS prophylaxis; Cognitive functioning