{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,13]],"date-time":"2025-11-13T18:17:43Z","timestamp":1763057863286},"reference-count":36,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2015,3,5]],"date-time":"2015-03-05T00:00:00Z","timestamp":1425513600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pediatric Blood &amp; Cancer"],"published-print":{"date-parts":[[2015,5]]},"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>There are no randomized controlled trials to inform the decision of which cranial radiation therapy (CRT) strategy to apply to pediatric patients with T\u2010cell acute lymphoblastic leukemia (ALL).<\/jats:p><\/jats:sec><jats:sec><jats:title>Procedure<\/jats:title><jats:p>We performed a decision analysis using a Markov model in which we compared the life expectancy and quality\u2010adjusted life expectancy when administering one of three CRT strategies to a cohort of patients with T\u2010cell ALL: (1) omission of CRT for all patients; (2) CRT only for those with evidence of leukemic involvement in the central nervous system at diagnosis (therapeutic strategy); or (3) CRT for all (prophylactic strategy).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>When considering plausible event\u2010free survival rates and late mortality after cure for groups of pediatric patients with T\u2010cell ALL, the strategies of omitting CRT, administering therapeutic CRT, and administering prophylactic CRT result in similar short\u2010term (7\u2010year) survival. When considering the increased contribution of deaths from late effects, the strategy of prophylactic CRT is associated with lower life expectancy when compared to the other two strategies. The Monte Carlo probabilistic sensitivity analysis demonstrated that the strategy of prophylactic CRT was the preferred strategy only 5% of the time.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Similar short\u2010term survival may be expected when comparing the strategies of total omission of CRT, therapeutic CRT, and prophylactic CRT for patients with T\u2010cell ALL. Long\u2010term survival is likely inferior for the strategy of prophylactic CRT. The synthesis of nonrandomized trials and the application of decision analysis can help inform complex decision making in pediatric oncology. Pediatr Blood Cancer 2015;62:790\u2013797. \u00a9 2015 Wiley Periodicals, Inc.<\/jats:p><\/jats:sec>","DOI":"10.1002\/pbc.25451","type":"journal-article","created":{"date-parts":[[2015,3,5]],"date-time":"2015-03-05T15:05:20Z","timestamp":1425567920000},"page":"790-797","source":"Crossref","is-referenced-by-count":18,"title":["Using nonrandomized studies to inform complex clinical decisions: The thorny issue of cranial radiation therapy for T\u2010cell acute lymphoblastic leukemia"],"prefix":"10.1002","volume":"62","author":[{"given":"Michael J.","family":"Kelly","sequence":"first","affiliation":[{"name":"Division of Pediatric Hematology\/Oncology The Floating Hospital for Children at Tufts Medical Center Boston Massachusetts"},{"name":"Department of Pediatrics Tufts University School of Medicine Boston Massachusetts"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stephen G.","family":"Pauker","sequence":"additional","affiliation":[{"name":"Division of Clinical Decision Making Department of Medicine Tufts Medical Center Boston Massachusetts"},{"name":"Institute for Clinical Research and Health Policy Studies Tufts Medical Center Boston Massachusetts"},{"name":"Department of Psychiatry Tufts Medical Center Boston Massachusetts"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Susan K.","family":"Parsons","sequence":"additional","affiliation":[{"name":"Department of Pediatrics Tufts University School of Medicine Boston Massachusetts"},{"name":"Institute for Clinical Research and Health Policy Studies Tufts Medical Center Boston Massachusetts"},{"name":"Department of Medicine Tufts University School of Medicine Boston Massachusetts"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2015,3,5]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2011.37.8018"},{"key":"e_1_2_7_3_1","unstructured":"IpS PaulusJK BalkEM DahabrehIJ AvendanoEE LauJ. 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