Purpose CNS tumours are the most common second primary neoplasm observed after childhood cancer in Britain, but the relationship of risk to dose of previous radiotherapy and chemotherapy is uncertain. Methods The British Childhood Cancer Survivor Study is a national population-based cohort study of 17980 individuals surviving at least 5 years after diagnosis of childhood cancer. Linkage to national population-based cancer registries identified 247 second primary neoplasms of the CNS. Cohort and nested case-control studies were undertaken. Results There were 137 meningiomas, 73 gliomas and 37 other CNS neoplasms included in the analysis. The risk of meningioma increased strongly, linearly and independently with each of dose of radiation to meningeal tissue and dose of intrathecal methotrexate. Those whose meningeal tissue received 0.01-9.99,10.00-19.99,20.00-29.99,30.00-39.99 and ≥40Gy had a risk 2,8,52,568 and 479-fold that experienced by those whose meningeal tissue was unexposed, respectively. The risk of meningioma among individuals receiving 1-39,40-69 and at least 70mg/m2 of intrathecal methotrexate was 15,11 and 36-fold that experienced by those unexposed, respectively. The standardised incidence ratio for gliomas was 10·8 (95% confidence interval: 8·5, 13·6). The risk of glioma/primitive neuroectodermal tumours increased linearly with dose of radiation and those with CNS tissue exposed to at least 40Gy experienced a risk 4-fold that experienced by those with CNS tissue unexposed. Conclusion The largest ever study of CNS tumours in childhood cancer survivors indicates the risk of meningioma increases rapidly with increased dose of radiation to meningeal tissue and increased dose of intrathecal methotrexate.

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Muscles affected in the long term are the muscles associated with pain and disability yet are not in the direct field of surgery or radiotherapy. Primary muscle shortening and secondary loss of muscle activity may be producing a movement disorder similar to the 'Dropped Shoulder Syndrome'. Exercise programmes should aim not only for range of movement but also for posture correction and education of potential long-term effects.