Comparable effects of 1800- and 2400-rad (18- and 24-Gy) cranial irradiation on height and weight in children treated for acute lymphocytic leukemia
P. J. Starceski, P. A. Lee, J. Blatt, D. Finegold and D. Brown
To examine the effects of "low-dose" cranial irradiation on growth and to
determine if one can predict patients in whom growth will be most affected,
we studied 47 children with acute lymphocytic leukemia who had been treated
with 2400 rad (24 Gy), 1800 rad (18 Gy), or no whole-brain irradiation.
Serial measurements of height, weight, and weight for height were obtained
by retrospective chart review. The effects of 1800 rad (18 Gy) and 2400 rad
(24 Gy) treatment were indistinguishable. Height percentiles among
irradiated patients decreased by a mean of 12% six months after diagnosis,
and growth generally did not catch up. Moreover, although 33 irradiated
patients maintained heights within the normal range, In 11 patients (33%) a
dramatic falloff occurred such that by three years following diagnosis
their height for age was more than 30 percentiles below the original value.
These patients were all identifiable at six months since their height
percentiles had already decreased by more than 15%. Although weight
percentiles did not change following irradiation, the weight-for-height
ratio increased and patients were relatively stockier three years after
therapy than they had been at diagnosis. In patients who had received
chemotherapy alone, the weight-for-height ratio also increased, but this
appeared to be due to a disproportionate increase in weight. Longer
follow-up and evaluation of larger cohorts of patients treated with 1800
rad (18 Gy) will be needed to confirm these results.
