ALL Cranial RT

[Haybrant]

Anyone treated cranial RT for ALL patients recently? Have a 43 year old with CNS involvement at the time of diagnosis being treated per a CALGB 8811/9566 protocol which calls for cranial RT. Based on protocol it is given at the same time as intrathecal MTX. I remember from training mtx being a very potent sensitizer and was a red flag to be sure it has time to clear before giving any cranial RT, but the protocol does seem to call for concurrent treatment on days 1-10. Anyone treated recently that can give me some reassurance. Thank you!

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[OTN]

I have only done it recently as a component of a TBI conditioning regimen pre-allo SCT. No concurrent MTX was given.

 

[Palex80]

Is the patient scheduled to undergo TBI later on as part of conditioning regimen vor allo-stem-cell-transplant?

What dose does the CALGB call for?

 

[Haybrant]

Is the patient scheduled to undergo TBI later on as part of conditioning regimen vor allo-stem-cell-transplant?

What dose does the CALGB call for?

Protocol called for 23.4 Gy but that has changed now the dose is either 12 in 8 or 18 in 10 so it is lower dose per fraction.

 

[Palex80]

Protocol called for 23.4 Gy but that has changed now the dose is either 12 in 8 or 18 in 10 so it is lower dose per fraction.

I wouldn't see much of an issue to deliver that dose parallel to MTX. Especially if no TBI is going to follow.

I find 8 x 1.5 Gy = 12 Gy quite a low dose for a CNS+ ALL...

 

[evilbooyaa]

Wouldn't give it same time as intrathecal MTX. 12 in 8 or 18 in 10 only makes sense, generally, when you're giving ~12Gy TBI immediately after completion of the brian boost.

I guess MTX + 12Gy brain RT might be a thing, but I'd rather them do just the chemo first...