Cranial radiation for pediatric T-lineage acute lymphoblastic leukemia: a systematic review and meta-analysis.
Cranial radiation for pediatric T-lineage acute lymphoblastic leukemia: a systematic review and meta-analysis.
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DOI：
10.1002/ajh.23784
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发表时间：
2014-10
影响因子：
12.8
通讯作者：
Parsons, Susan K.
中科院分区：
文献类型：
--
作者：
Kelly, Michael J.;Trikalinos, Thomas A.;Dahabreh, Issa J.;Gianferante, Matthew;Parsons, Susan K.
There are heterogeneous approaches to cranial irradiation therapy (CRT) for T-lineage acute lymphoblastic leukemia (T-ALL). We performed a systematic review of studies that specified a radiation strategy and reported survival for pediatric T-ALL. Our analysis included 62 publications reporting 78 treatment groups (patient n=5844). The average event-free survival (EFS) was higher by 6% per 5 years (p<0.001). Adjusting for year, EFS differed by radiation strategy. Compared to the reference group (CRT for all) which had a year-adjusted EFS of 65% (95% confidence interval, CI: 61% to 69%) the adjusted EFS was significantly worse (rate difference (RD) = -9%, 95% CI: -15% to -2%) among studies that used a risk-directed approach to CRT (p=0.004). The adjusted EFS for the other strategies were not significantly different compared to the reference group: CRT for central nervous system positive patients only (RD = -3%, 95% CI: -14% to 7%, p=0.49); CRT omitted for all patients (RD = 5%, 95% CI: -4% to 15%, p=0.33). CRT may not be necessary with current chemotherapy for T-ALL. These associations, however, are susceptible to bias and caution should be applied in drawing definitive conclusions on the comparative effectiveness of alternative CRT strategies.
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