In children with acute lymphoblastic leukemia (ALL), radiation therapy to prevent the cancer from returning in the brain is likely unnecessary, according to a new study. Radiation can even be omitted for children at the highest risk of the cancer coming back, the study showed. Over the 10-year course of the clinical trial, only 8 out of the 598 children in the study had a relapse that involved their central nervous system (CNS). Six of the 8 children were successfully treated with additional therapies and were still alive at the time of the study’s publication. “Given the long-term risks of CNS radiation therapy, particularly in younger children, this [study] is really important,” said Nirali Shah, M.D., of NCI’s Pediatric Oncology Branch, who was not involved with the trial. “We're at the end of an era,” said Ching-Hon Pui, M.D., of St. Jude Children’s Research Hospital, who led the study. With modern chemotherapy regimens, “no child with ALL really should get prophylactic radiation.” Results from the St. Jude Total Therapy Study 16 were published October 28 in the Journal of Clinical Oncology.