Guidelines for Complications of Cancer Treatment Vol VIII Part B

Randomized trial in craniospinal radiation dose (36 Gyversus 23.6 Gy) had shown that with lower dose of CSI(23.6 Gy) there is significantly less reduction of bothneuropsychological and neuroendocrine functioncompared with higher dose CSI (36 Gy) (Mulhern 1998).Randomized study had shown that lower age (23.6 Gy) have deleteriouseffect of cognitive function. However, patients withrecurrent disease also had significantly worse quality oflife and cognitive function.In PNET 3 study, health status was significantly poorerin the group treated with CSI plus chemotherapy than inthe CSI alone arm, and there were also trends to pooreroutcomes for behavior and quality of life scores.Prophylactic cranial radiation (PCI) in acute leukemia(ALL) had shown to reduce neurocognitive function andhas been assessed by randomized trial with long termfollow up data. Poorer performance after PCI wasindependent of sex of the patient, time since treatmentand age at diagnosis. Data suggest that addition of 2,400cGy PCI cranial in ALL increases the risk for mild globalloss in intellectual and neuropsychologic ability.Randomized trials had shown that young ALL patientstreated with lower dose of PCI (18 Gy) had significantlyless reduction of Full-Scale, Verbal, and PerformanceIQ as measured with WISC Scale compared with 24 GyPCI. Thus, reducing PCI dose from 2400 cGy to 1800cGy reduces neurotoxicity to acceptable levels.Neurological function assessment by activity of dailylivingFunctional activity is assessed by more objective methods withactivity of daily living measurements (ADL). Activity of dailyliving (ADL) is a battery of tests done to assess ‘functional348