Meningioma after radiotherapy for malignancy

Abstract

Complications of radiation exposure have gained importance with increasing cancer survivorship. Secondary malignancies have been associated with cranial radiation exposure. We present our experience with intracranial radiation-induced meningioma (RIM) and discuss the implications of its presentation and natural history for patient management. Patients diagnosed with meningioma who had received radiation therapy between 1960 and 2014 were identified. Records were retrospectively reviewed for details of radiation exposure, previous malignancies, meningioma subtypes, multiplicity and pathologic descriptions, treatment and follow-up. Thirty patients were diagnosed with RIM. Initial malignancies included acute lymphocytic leukemia (33.3%), medulloblastoma (26.7%) and glioma (16.7%) at a mean age of 8.1 years (range 0.04–33 years). The mean radiation dose was 34 Gy (range 16–60 Gy) and latency time to meningioma was 26 years (range 8–51 years). Twenty-one patients (70%) underwent surgery. Of these, 57.1% of tumors were World Health Organization (WHO) grade I while 42.9% were WHO II (atypical). The mean MIB-1 labeling index for patients with WHO I tumors was 5.44%, with 33.3% exhibiting at least 5% staining. Mean follow-up after meningioma diagnosis was 5.8 years. Mortality was zero during the follow-up period. Meningioma is an important long-term complication of therapeutic radiation. While more aggressive pathology occurs more frequently in RIM than in sporadic meningioma, it remains unclear whether this translates into an effect on survival. Further study should be aimed at delineating the risks and benefits of routine surveillance for the development of secondary neoplasms after radiation therapy.

Adjuvant postoperative high-dose radiotherapy for atypical and malignant meningioma: A phase-II parallel non-randomized and observation study (EORTC 22042-26042)

“…Six 6 events (50%) were likely related to RT. Caution must be heeded when administrating radiotherapy to brain tumors, as adverse events secondary to radiotherapy, not limited to but including cognitive impairment [26], pituitary dysfunction [27] and secondary brain tumors [28] are well known. The majority of Table 3 Emergent signs and symptoms # (using CTCAE version 3.0).…”

Current Clinical Brain Tumor Imaging

“…Radiation-associated meningiomas tend to occur at a younger age and are more often multiple when contrasted with sporadic meningiomas (Figure 13). 173,174 Radiation-associated gliomas are usually a high-grade astrocytoma occurring in the radiation field with imaging features indistinguishable from a primary glioma. 171 …”

A Comprehensive Review of Pediatric Tumors and Associated Cancer Predisposition Syndromes

“…They account for about 1-3% of pediatric CNS tumors (Dolecek et al 2012;Kaderali et al 2009). Meningiomas may occur as treatment related secondary cancers in pediatric patients within the radiation field; however they can be a long-term complication of cancer therapy, which may not present before adulthood (Morgenstern et al 2016). The majority of meningiomas are sporadic and may be asymptomatic (Kuratsu et al 2000), as 1-2% are first identified on autopsy (Nakasu et al 1987).…”