More good news for childhood leukemia patients
Submitted by Dr.Kattlove’s Cancer Blog
I often tell this story to illustrate the harmful effects of radiation therapy to the brain. I treated a teen-age patient with acute lymphoblastic leukemia, the kind most common in children. The treatment protocol in those days called for radiation treatment to the brain, because chemotherapy didn’t penetrate into the brain very well even if it was given into the spinal canal. Past experience told us that without radiation to the brain, the leukemia could come back there.
He was a very smart young man and told me that when he went to college he wanted to major in mathematics because he was really good at it. But, after his radiation was complete, he confessed that he had lost some of his math smarts and perhaps would settle for something less challenging, like becoming a doctor. I was both chagrined and pleased. Chagrined because my treatment had damaged some of his brain power and pleased because he took doctors (like me?) as a role model.
We have known for a long time that radiation to the brain, particularly in young children is harmful. It can definitely lower their IQ, and may contribute to the development of brain tumors. A recent survey from Scandinavia found that the rate of brain cancer in survivors of childhood cancer was eight times that of the general population. I suspect many of these survivors had received brain radiation, although the study report did not go into specifics of treatment.
Because of these problems, pediatric oncologists have been striving to avoid radiating the brain of children with leukemia and now have finally succeeded. The report was published in the June 25, 2009 issue of the New England Journal of Medicine.
The researchers, led by the team at St. Jude Children’s Hospital in Memphis, were able to cure nearly 95 percent of their patients without resorting to radiation treatment of the brain except in a very few cases. They did it by giving the children high doses of a chemotherapy drug called methotrexate and by multiple injections of 3 different chemotherapy drugs into the spinal fluid.
Eleven patients out of a total of 498 saw their leukemia relapse in the brain, and these were treated, apparently successfully, with radiation. So there are two bits of good news here. First is the high cure rate. Remember that this was a fatal disease until 50 years ago when the first anti-leukemia drug was developed. That drug was methotrexate, the same drug used in the St Jude program, but then it was used at much lower doses.
The second bit of good news is that we won’t lose any potential mathematicians. Of course that won’t solve the doctor shortage, but since bond trading has lost its appeal, we may have more than enough applicants to medical school
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