REDUCED INCIDENCE OF THE SOMNOLENCE SYNDROME AFTER PROPHYLACTIC CRANIAL IRRADIATION IN CHILDREN WITH ACUTE LYMPHOBLASTIC-LEUKEMIA

A prospective double blind randomized trial comparing two different do se schedules of continuous steroid coverage during prophylactic crania l radiotherapy (CRT) in leukemic children was conducted to find out th e optimum dose to be prescribed to reduce the incidence of Somnolence Syndrome (SS). Between April 1994 and February 1996, 32 patients with acute lymphoblastic leukemia received CRT of 18 Gy in 10 fractions. Pa tients were randomized to receive oral dexamethasone of 2 or 4 mg/m(2) during radiotherapy. The diagnosis of SS was made clinically based on symptoms of somnolence. All patients were followed for a minimum of 8 months. The overall incidence of SS was 40%. The development of SS wa s steroid dose dependent. In low dose steroid arm the incidence of SS was 64.3% (9/14), compared to 17.6% (3/17) in high dose arm with stati stically significant difference (P = 0.008). The median time to develo pment of SS was 4 weeks. The most common symptom of SS was drowsiness followed by anorexia, headache, nausea, vomiting, decreased activity, irritability, fever and ataxia, respectively. The duration of symptoms ranged from 2 to 14 days. The development of SS was not related to th e presence of acute reactions, age at the time of CRT and sex. In all cases the symptoms subsided completely and spontaneously. Our results suggest that steroid coverage at a dose of 4 mg/m(2) during CRT reduce s the incidence of SS. However, a multicentric prospective randomized trial is needed to determine the role and the optimal dose of steroid. (C) 1998 Elsevier Science Ireland Ltd. All rights reserved.