Childhood intracranial meningiomas after high-dose irradiation

Abstract

Background. Irradiation, either alone or in association with other factors, is thought to play a role in the causation of intracranial meningioma. Methods. The authors report two 15‐year‐old patients with convexity meningiomas as a result of high‐dose irradiation received at a young age and review the English language literature reports of 13 pediatric patients with meningiomas after high‐dose irradiation. The clinical characteristics of the 15 patients are presented. Results. There were nine girls and six boys. The mean age at the time of irradiation was 2.5 years (2 months‐9 years), and the mean age at diagnosis of meningioma was 13 years (5–15.5 years). The mean radiation dose was 4154 cGy (1500–8000 cGy). In 11 of the 15 patients, the meningioma was located in the calvarial area. Only 1 of 15 had multiple tumors, and only two of the tumors were clearly malignant at diagnosis. In ten patients, gross total resection was recorded, and two patients underwent subtotal resection. Three died of recurrent/disseminated meningiomas. Conclusions. This study suggests that meningiomas after high‐dose radiation in children are mostly calvarial in location, rarely multiple, mostly benign in histologic type, and that complete removal is possible in most patients. The age at the time of radiation is young (mean age, 2.5 years) and the latent period is short (mean, 10.8 years). Although the clinical course of radiation‐induced meningiomas in childhood generally is benign, high doses of radiation at a young age are to be avoided, and other means of therapy should be used if possible.

Radiation-induced meningioma

“…In their survey of reported cases of RIM in patients exposed to high-dose radiation, Strojan et al 78 observed average latency of 18.7 years and also noted shorter latency in patients in whom radiation treatments were administered at younger ages. Ghim et al 17 found a mean latency of only 10.8 years (range 5-15.5) in a study of 13 pediatric high-dose RIM patients with mean age at diagnosis 13 years (range 6-18). These patients had been treated for brain tumors at an average age of 2.5 years.…”

“…3,28 Harrison et al 24 grouped RIMs into 3 categories: those due to high-dose (Ͼ 20 Gy), intermediate-dose (10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20), and low-dose (Ͻ 10 Gy) radiation. Other authors define doses Ͼ 10 Gy as high.…”

“…Several authors have summarized up to 126 cases of high-dose RIMs reported in the literature between 1953 and 2002. 4,17,42,66,67,78,81 The radiation doses ranged from 22 to 87 Gy, and the majority of patients had undergone radiotherapy as children. The mean latency from irradiation to diagnosis of the meningioma was ~ 19 years, 42,67 with a tendency for shorter latency in patients treated with higher doses and those who had undergone radiotherapy at younger ages.…”

“…The mean latency from irradiation to diagnosis of the meningioma was ~ 19 years, 42,67 with a tendency for shorter latency in patients treated with higher doses and those who had undergone radiotherapy at younger ages. 2,17,24,32,42,78 …”

“…The authors of several large studies conducted in Israel have documented a primarily calvarial location in patients treated for tinea capitis. 59,64,75 Ghim et al 17 found that 11 of 13 pediatric patients with high-dose RIMs had calvarial meningiomas, whereas skull base meningiomas were found in 4-19% of patients with RIM in whom there was a history of high-dose irradiation for primary brain tumors. 39,59,67,76 Epidemiological studies of patients with RIM linked to full-mouth dental x-rays have shown that skull base meningiomas are more common following this type of radiation exposure.…”