Side effects and late results of the combined radio- and chemotherapy of the brain in children with acute lymphoblastic leukemia

In case of lymphoblastic leukemia, acute general side effects of the therapy phase II which occured, mostly in the form of gastric troubles, in 42,0% of the 50 children, have to be attributed to the skull irradiation as well as to the intrathecal MTX injections. Irritations of the meninges provoked in the course of phase II appeared in the form of a liquor pleocytosis in 44,7% of 38 children and in the form of an augmentation of the liquor proteins in 23,6%. Considering the success of the meningiosis prophylaxis, alopecia must be tolerated. In 66,0% of the 50 cases, the syndrome of somnolescence was found two to nine weeks after phase II; this syndrome is considered to be reversible, and no late damages are known until now. A therapy control is possible by periodical neurologie examinations and electroencephalography: after phase II, a normal EEG is found in 66,7% of 39 cases; a pathological EEG is found in 28,2% of the cases with preliminary EEG and in 5,1% of the cases without preliminary EEG. The psychic development of the children submitted to a central nervous system prophylaxis can only be judged in a reliable manner if comparative tests are executed. The irradiation dose to the skull during phase II is within the generally accepted tolerable values; seven children were dissected, and the neurohistologic examinations produced no evidence of late irradiation damages. (orig.)