Neurocognitive Side Effects of High Dose Methotrexate and Cranial Radiotherapy in Acute Lymphoblastic Leukemia Patients on Bfm 86 Protocol Treatment.

Introduction: Cancer in children is rare: only 1 or 2 children per 10,000 are diagnosed With it each year. Nevertheless, it is the leading cause of death by disease in Children under 5 years old. In the USA, 5-year survival for all type of childhood Cancers increased from 51% in 1973 to79% in 1997[1] Incidence of childhood Cancer in India is 9 per million [2]. Advances in the early diagnosis and treatment Of pediatric cancers have led to dramatic increases in survival rates, especially For diseases such as leukemia. Several decades ago, a diagnosis of acute Lymphoblastic leukemia (ALL) was almost always fatal, but a child diagnosed with It today has about a 90% chance of long-term survival (>5 years). 5 year survival Rates for childhood cancers have reached 55% in our institute[3]. The use of Prophylactic cranial radiotherapy (CRT), High dose methotrexate and multidrug Regimens are largely responsible for this success [4]. The therapy responsible for This survival can also produce adverse neurocognitive side effects. In an effort to Reduce the side effects most of the international protocols has avoided cranial Radiotherapy in low risk ALL cases and reduced the dose of presymptomatic cranial Radiotherapy in others. As an alternative to cranial radiotherapy high dose Methotrexate is also incorporated in many of the protocols. But still a small subset Of ALL cases end up receiving both cranial radiotherapy and high dose Methotrexate [5-9]. There is paucity of literature regarding the neurocognitive side Effects of combined cranial radiotherapy [CRT] & High dose methotrexate. Aim of the study To prospectively study the immediate Neurocognitive side effects of combined Presymptomatic cranial radiotherapy and High dose methotrexate on Acute Lymphoblastic leukemia patients during BFM 86 protocol treatment