Treatment Option Overview
CNS-directed therapy is provided during premaintenance chemotherapy by all groups. Some protocols provide ongoing intrathecal chemotherapy during maintenance (COG, St. Jude Children's Research Hospital [SJCRH], and Dana-Farber Cancer Institute), while others do not (Berlin-Frankfurt-Muenster).
Overt testicular involvement at the time of diagnosis occurs in approximately 2% of males. In early ALL trials, testicular involvement at diagnosis was an adverse prognostic factor. With more aggressive initial therapy, however, the prognostic significance of initial testicular involvement is unclear.[24,25] The role of radiation therapy for testicular involvement is also unclear. A study from SJCRH suggests that a good outcome can be achieved with aggressive conventional chemotherapy without radiation. The COG has also adopted this strategy for boys with testicular leukemia that resolves completely during induction chemotherapy.
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