Standard treatment

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Standard treatment is the best known treatment for a specific type of cancer. For instance, in 2002, the standard treatment for intermediate-risk ALL is combination chemotherapy for two to three years. The standard treatment for high-risk ALL includes more drugs and may include cranial radiation and/or stem cell transplant for very high-risk groups.

As results from ongoing and completed clinical trials are analyzed, more knowledge is accumulated and standard treatments evolve. In the 1980s, most children with ALL received cranial radiation as standard care. Carefully controlled clinical trials established that the majority of children with ALL do not require cranial radiation. The standard-of-care was changed.

Most clinical trials divide patients into two or more groups ("arms" of the trial). One arm is the standard-of-care (best treatment known), and the other arms are the experimental portions, which scientists hope will prove to be more effective or less toxic than the standard treatment. The trial is designed to compare the experimental arms to the standard arm, to determine whether patients will benefit.

In the early 1990s, my daughter's clinical trial for high-risk ALL had three arms. One arm was the standard treatment of four drug rotations of chemotherapy with a delayed intensification and consolidation, and 1,800 rads of cranial radiation. The second arm was identical except radiation was replaced with more frequent doses of intrathecal methotrexate. The third arm was for children who had CNS disease at diagnosis or who were slow responders to initial therapy. They received a very aggressive chemotherapy regimen plus cranial radiation.

The purpose of the study was to compare response to treatment, duration of disease control, and side effects. The investigators hoped to be able to eliminate radiation from the standard care for high-risk ALL.

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