disability have led to changes in use of adjuvant therapy.
A classic example is the use of cranial radiation for cen-
tral nervous system prophylaxis for acute lymphoblastic
leukemia (ALL) in children, which at one time received
widespread use. Hill and colleagues
conducted a study
that demonstrated that cranial radiation contributed to
deficits in attention and overall intellectual functioning in
these children. Two groups of survivors of childhood ALL
were compared: one group had been treated with 24 Gy of
cranial radiation and intrathecal methotrexate; the other
had received systemic and intrathecal methotrexate but
no cranial radiation. The group who had received cranial
radiation had significantly worse academic achievement
and greater psychological distress. As a result, intensive
efforts were made to find effective alternatives to cranial
radiotherapy to prevent recurrence or relapse, such as
high-dose systemic chemotherapy and intensive intrathe-
cal therapy.