Would you recommend prophylactic cranial irradiation (PCI) for a teenager with a T cell acute lymphoblastic leukemia in remission?

No—modern systemic and CNS directed therapy is sufficient to mitigate the historic higher risk of CNS relapse (Vora et al., JCO 2016). While there is still a small risk of cranial relapse with modern systemic therapy, the improved success of response and risk adapted strategies utilizing varying degrees of CNS RT is typically sufficient to limit an adverse effect on overall survival (Barredo et al., JCO 2006). Even higher risk subsets can be successfully managed with triple-agent intrathecal the...