Various protocols have used varying radiation dosages and used it for different indications and/or leukemic "load".
What is the current consensus opinion about:
1) How and when to use it?
2) Is there a cut off of the numbers of leukemic cells (say above or below 20,000/mm3) that CNS prophylaxis cannot be used?
3) Has anyone matched with the possibility of various chromosomal translocations that are part and parcel of development of ALL/AML or it's Chronic variants?
4) Dose of the therapy required?
5) Field set up?
6) Is CSI really required?
7) Do we have a "meta analysis" on this?
8) Are the risks of radiation really over stated? I do think so because no one mentions the risk associated with intra-thecal methotrexate or other drugs which are given in combination to cross the blood brain barrier. Indeed, there might be a close temporal association with chemotherapy and radiation but I feel that the associated risks have been bloated up by Pediatric Oncologists including the risk of secondary malignancies. In so much that the secondary malignancies are very much possible with the given chemotherapeutic drugs also. At the same time, multiple balanced and unbalanced translocations, deletions and gain of functions with various sub variants could also possibly be a risk factor; radiation MAY or MAY NOT potentiate those risks.
9) Is the isocentre placed over the edge of the orbit or preferable to tilt the gantry to avoid anterior beam divergence in the parallel opposed fields?Which one is preferable?
Thanks in advance!
Reality is merely a persistent illusion