OBJECTIVE
Radiation-induced meningioma (RIM) is a rare but serious consequence of cranial and cranio-spinal external beam radiation therapy (EBRT). While recent studies have characterized the epidemiological features of RIM in small populations or systematic reviews, none have studied RIM within a national database for a more generalizable description of this disease entity. The objective of this study was to identify and characterize the population with RIMs within a large national database.
METHODS
From the SEER Research Plus Nov 2020 (1975-2018) dataset, 56161 patients treated with EBRT for the following indications were identified: ocular/orbital tumors, brain/nervous system tumors, and leukemias. Next, a sub-population of 185 RIM patients, defined by histologically distinct precedent tumor treated with EBRT and a minimum 5-year latency from EBRT to meningioma, was identified. RIM prevalence, latency, pathologic behavior, and multiplicity were determined, and comparisons were made by sex, race, and original indication for EBRT.
RESULTS
The prevalence of RIM among the EBRT population was 0.33%. Among RIM patients, 41.62% were male and 84.32% were Caucasian. Average latency to RIM development was 23.39 ± 8.65 years, with no significant difference between sexes or races. Fourteen patients had multiple RIMs at diagnosis, while four patients experienced recurrent RIM. RIMs classified as “malignant” had a shorter latency (16.30 years) than “borderline” (26.11 years) or “benign” (23.36 years) RIMs. Of the most common original EBRT indications, precursor lymphoblastic leukemia (29.89 years) had longer latency to RIM than medulloblastoma (21.57 years) or astrocytoma (22.67 years); this may be explained by lower doses of radiation used for lymphoblastic leukemia treatment.
CONCLUSION
These data provide novel epidemiological information—most importantly, prevalence—of RIM in a nationwide population, and they suggest that RIM occurs in patients independent of sex or race. These findings will aid clinicians in explaining the risk of RIM development to patients undergoing EBRT.
OBJECTIVE
Radiation-induced meningiomas (RIM) are the most common secondary neoplasm arising from radiation therapy. RIM have not been characterized in pediatric populations on a national scale despite displaying shorter latency and higher malignancy rates in institutional studies. The objective of this study was to characterize pediatric RIM and compare latency and malignancy rates to those of adult RIM using the National Cancer Institute’s Surveillance, Epidemiology and End Results Program (SEER) database.
METHODS
From the SEER Research Plus Nov 2020 (1975-2018) dataset, 56161 patients treated with EBRT for ocular/orbital tumors, brain/nervous system tumors, and leukemia were identified. 185 patients meeting criteria for RIM were selected: cranial/spinal EBRT (presumed from diagnostic indication), histologically distinct precedent tumor treated with EBRT, and a minimum 5-year latency from EBRT to meningioma diagnosis. This sub-population was divided into 2 groups – pediatric (ages 0-19, n = 10) and adult (ages > 20, n = 175) RIM – and latency, recurrence rate and multiplicity were compared for each group. The number of tumors classified as malignant (as opposed to benign or borderline malignant) was also compared between groups. Additionally, demographic data were compared for each group.
RESULTS
Of the pediatric RIM patients, 70% were male, 70% were Caucasian, and 10% were African American. No pediatric RIM patients experienced a recurrence or presented with multiple RIMs. The pediatric group showed lower latency (11.00 ± 1.94 years, p < 0.001) and a higher malignancy rate (30%, p = 0.002) than the adult group (latency of 23.38 ± 8.69 years; malignancy rate 5.1%).
CONCLUSION
These data represent the first characterization of pediatric RIM from a national database and support prior findings of shorter latency and higher malignancy rates in pediatric vs adult RIM, as well as lay the groundwork for future nationwide monitoring of this rare yet highly significant complication.
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