There is no risk stratification consensus in adult leukemia. Although many classifications are used based on age, disease characteristics and treatment response. (14) Adult ALL are generally taken as high risk group, adolescent ALL are high risk in pediatric protocol. This gave us the impetus to evaluate the results of our institutional protocol of using slanting field technique with dose of 18 Gray in 10 fractions in the adolescent and adult population group. MATERIALS AND METHODS: This is a retrospective analysis of adolescent and adult population of Acute Lymphocytic Leukemia (ALL), from year 2008-2012, of our institute being treated for leukemia and with cranial irradiation. Prophylactic cranial irradiation was given in the patients having been completed the induction phase of remission. Documentation of bone marrow under remission and a negative CSF cytology was obtained. Radiotherapy was delivered once blood counts were normal. Radiotherapy was delivered using the slanting field technique, using 6 MV photons with bilateral parallel opposed beams upto 18 Gray in 10 fractions at the rate of 1.8 Gray per fraction for 5 days a week for 2 weeks. Radiotherapy volume included all the intracranial contents, the subarachnoid space and the meninges. Care was taken to avoid the lens by placing the lateral border at the canthus. Inferior most extent was kept at the caudal border of the second cervical vertebrae. The prescribed dose was calculated at midplane. (18) RESULTS: We evaluated 430 ALL patients from the year 2008-2012. 314 of the patients were males and 116 were females. Male to female ratio being 2.71:1. 153 were adolescents, 90 patients were from age group 20-29yrs, 51 patients belonged to age group from 30-39 yrs, 83 patients were of 40-49 yrs, 37 patients were of age 50-59yrs, 16 patients were more than 60 yrs. 86 patients were of T-cell type and rest 344 were B-cell type. Philadelphia chromosome was positive in 96/430
Larson, R. A., Dodge, R. K., Burns, C. P., et al. (1995). A five-drug remission induction regimen with intensive consolidation for adults with acute lymphoblastic leukemia: Cancer and leukemia group B study 8811. Blood, 85, 2025–2037. Ellison, R. R., Mick, R., Cuttner, J., et al. (1991). The effects of postinduction intensification treatment with cytarabine and daunorubicin in adult acute lymphocytic leukemia: A prospective randomized clinical trial by Cancer and Leukemia Group B. Journal of Clinical Oncology, 9, 2002–2015. Goldstone, A. H., Richards, S. M., Lazarus, H. M., et al. (2008). In adults with acute lymphoblastic leukemia, the greatest benefit is achieved from a matched sibling allogeneic transplantation in first complete remission, and an autologous transplantation is less effective than conventional consolidation/maintenance chemotherapy in all patients: Final results of the International ALL Trial (MRC UKALL XII/ECOG E2993). Blood, 111, 1827–1833. Rowe, J. M., Buck, G., Burnett, A. K., et al. (2005). Induction therapy for adults with acute lymphoblastic leukemia: Results of more than 1500 patients from the International ALL trial: MRC UKALL XII/ECOG E2993. Blood, 106, 3760–3767. Jabbour, E. J., Faderl, S., and Kantarjian, H. M. (2005). Adult acute lymphoblastic leukemia. Mayo Clinic Proceedings, 80(11), 1517–1527. (4), 813–818. A.S. Advani and H.M. Lazarus (eds.), Adult Acute Lymphocytic Leukemia, Contemporary Hematology. Chapter 14 Treatment of Acute Lymphoblastic Leukemia in Young Adults p 211.