Radiation Not Needed for Childhood Cancers

Two new studies show side effects of treatment show up later

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By
HealthDay Reporter

(HealthDay is the new name for HealthScoutNews.)

WEDNESDAY, Aug. 13, 2003 (HealthDayNews) -- Two new studies show radiation can affect how long and how well children survive cancer.

The first study found children with acute lymphoblastic leukemia who received chemotherapy but not radiation to the brain area tended to live longer and with a better quality of life than those who got both treatments. But the long-term outcomes for both groups were quite high.

The second study found the risk of hospitalization for psychiatric disorders is no higher among survivors of cancer in childhood or adolescence. The one striking exception was among those who had had brain tumors, for which radiation is the standard treatment.

Both reports appear in the Aug. 14 issue of the New England Journal of Medicine.

"Neither [study] has anything smashingly new to say, but they are good studies because they involve a relatively large number of patients that confirm some things that we already knew to some extent," says Dr. Joseph V. Simone, author of an accompanying editorial.

Referring to the first study on children with acute lymphoblastic leukemia, Dr. William Carroll, division chief of pediatric oncology at New York University Medical Center, says, "Cure rates for childhood leukemia are one of the success stories."

"The question has been now that we're curing all these patients, what problems are going to surface 20, 30 years later," he adds. "This study shows quite strikingly that the survival of these patients is no different from the general population so once you've gone that long you should be considered normal. And that has profound implications for everything from getting insurance to how you're viewed in society. When we say cure, we mean cure."

According to the National Cancer Institute, acute lymphoblastic leukemia, or ALL, is the most common form of leukemia in children and the most common type of childhood cancer. Patients suffering from this disease have too many underdeveloped white blood cells.

The research team looked at 856 patients who had been treated in clinical trials at St. Jude Children's Research Hospital in Memphis between 1962 and 1992. The patients, all of whom had survived at least 10 years, were divided into two groups: Those who had received radiation and those who had not.

Participants who did not receive radiation therapy and who had survived to the 10-year mark without any new or recurring illness can expect to live a normal life, the authors conclude. "Normal" refers both to length and quality of life.

"Patients who never received radiation to the brain had normal survival compared to the general population," says study author Dr. Ching-Hon Piu, director of the Leukemia Lymphoma Division at St. Jude. "Employment and marriage rates were the same as the general population, as well as insurance rates."

The mortality rate for the group that received radiation was slightly higher than the general U.S. population.

While men and women in the radiation group had health insurance rates similar to the general population, they had higher unemployment rates. In the radiation group, 15.1 percent of men were unemployed, compared to 5.4 percent of the general population. And 35.4 percent of women were unemployed, versus 5.2 percent of the general population. Women who had received radiation were also less likely to be married (only 35.2 percent were married, versus 48.8 percent of the general population).

Piu attributes these differences to brain damage resulting from the radiation treatments.

For the second study on hospitalization for psychiatric disorders, the study authors, based in Denmark, looked at 3,710 people who had survived at least three years after being diagnosed with cancer in childhood or adolescence.

Although more people in this group were hospitalized for a psychiatric condition than would be expected in the general population, that higher number was entirely due to brain tumor survivors. These individuals were 80 percent more likely to be hospitalized.

"We've known for 15 or 20 years that a child, depending on the [type of cancer] and the age of the child, runs a risk of neuropsychosocial effects," Simone says. "We've spent a long time figuring out what it is about the radiation to try to refine treatment."

Largely as a result of this long-running research, radiation is no longer used as a primary treatment for most childhood cancers (the notable exception being brain cancer).

"We know now that with chemotherapy these kids do fairly well so there's really no need to irradiate them unless they have overt central nervous system disease," says Dr. Shipra Kaicker, a pediatric hematologist/oncologist at Maimonides Medical Center in New York City.

The point, Simone says, is that follow-up is necessary to assess and improve upon treatment for childhood cancer. The psychiatric study was possible because of the exceptionally thorough health-care records kept in Denmark, which has universal health care. In the United States, many patients are lost to follow-up, suggesting the need for more systematic methods for following childhood cancer patients.

Simone cites a report due out in October from the U.S. Institute of Medicine that will try to provide a road map for studying these individuals.

More information

The National Cancer Institute has more on acute lymphoblastic leukemia, and childhood cancers.

SOURCES: Ching-Hon Pui, M.D., director, Leukemia Lymphoma Division, St. Jude Children's Research Hospital, Memphis, Tenn.; Joseph V. Simone, M.D., president, Simone Consulting, Dunwoody, Ga., clinical director emeritus, Huntsman Cancer Institute, and professor emeritus, pediatrics and medicine, University of Utah, both in Salt Lake City; Shipra Kaicker, M.D., pediatric hematologist/oncologist, Maimonides Medical Center, New York City; William Carroll, M.D., division chief, pediatric oncology, New York University Medical Center, and professor, pediatrics, New York University School of Medicine, both in New York City; Aug. 14, 2003, New England Journal of Medicine

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