Incidence of second brain tumours after pituitary irradiation in Edinburgh 1962–1990

Bliss, P.; Kerr, G.R.; Gregor, A.

doi:10.1016/s0936-6555(05)80187-6

Cited by 75 publications

(39 citation statements)

References 17 publications

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“…Meningioma was diagnosed many years after RxT only in two patients. The occurrence of a second neoplasm in the field of irradiation has been already described as a rare event (41)(42)(43). In our opinion the causal relationship between the two events needs to be demonstrated, with the use of a proper control group (non-irradiated acromegalics), because we have observed the occurrence of meningioma even in some acromegalic patients not irradiated and an increase of tumor prevalence has been already shown in this population (3).…”

Section: Discussionmentioning

confidence: 63%

Failure of radiotherapy in acromegaly

Cozzi¹,

Barausse²,

Asnaghi

et al. 2001

European Journal of Endocrinology

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Background: Recent data has raised skepticism regarding the long-term effectiveness of radiotherapy (RxT) in acromegaly and its role as an ancillary tool to neurosurgery (Tx). Patients: We evaluated 72 acromegalic patients previously submitted to RxT. Data were discarded in 23 patients, who were lost to follow-up, operated on after RxT or irradiated with techniques different from external conventional fractionated RxT. Among the remaining 49 (five with mixed GH-prolactin adenoma), 34 were irradiated after surgical failure and 15 as primary treatment. A second cycle of RxT was administered in two. Results: (i) GH/IGF-I. After a median follow-up of 14 years (range 3-41), normal age-matched IGF-I levels were reached in eight patients (16%) after 10 years, and GH levels ,2.5 mg/l in six (12%) after 9 years. The rate of persistently pathological hormonal levels was still 90% at 25 years. All patients with GH/IGF-I normalization had undergone irradiation without any antisecretory drug. Neither basal GH nor tumor size affected the outcome of RxT. In three patients (6%) a relapse/worsening occurred. (ii) Tumor size. Tumor shrank after 8.5 years in 24 patients (49%), in nine of whom during GH-suppressive treatment. Tumor shrinkage was not predictive of hormonal normalization. (iii) Side-effects. Hypopituitarism was diagnosed in four patients (selective in three and global in one) and GH deficiency in one. Three patients had neurological side-effects and meningioma was shown in two patients. Conclusion: RxT is unable to cure acromegaly, because it seldom achieves hormonal normalization even after a very prolonged follow-up. Concomitant antisecretory treatment seems to counteract its effects. RxT can still play a role in those patients with large tumor remnants, because of its capacity to shrink tumor size.

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Section: Discussionmentioning

confidence: 63%

Failure of radiotherapy in acromegaly

Cozzi¹,

Barausse²,

Asnaghi

et al. 2001

European Journal of Endocrinology

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“…First, they usually have a long latency period after radiation: although a wide range in the latency period has been reported following high-dose radiation (12 Brain tumour stem cell-mediated radiation-induced meningioma months to 63 years), the mean latency period is 18.7 ± 10.2 years. 2,3,6,7,25,26 Secondly, most patients were juveniles: of the patients whose ages were reported, all were in the paediatric age group (the majority < 5 years old at the time of cranial radiation following brain tumour diagnosis) except for one young adult patient. This may be because more chromosomal injury is caused by radiation in the developing nervous tissue of young children 7 and the meninges of children are extremely sensitive and, thus, more vulnerable to radiation.…”

Section: Discussionmentioning

confidence: 99%

Possible Involvement of Brain Tumour Stem Cells in the Emergence of a Fast-Growing Malignant Meningioma after Surgical Resection and Radiotherapy of High-Grade Astrocytoma: Case Report and Preliminary Laboratory Investigation

et al. 2009

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The case of a 62-year old man diagnosed with radiation-induced meningioma (RIM) after treatment for astrocytoma with an unusually short latency period of 7 months is reported. The patient first presented with a 2-month history of memory decline. Magnetic resonance imaging (MRI) showed a tumour in the left parieto-temporal lobe. Gross total resection was performed and the tumour was confirmed to be an astrocytoma. The patient received cranial radiotherapy 2 weeks later, however 7 months after radiation treatment the patient presented with headache and vomiting. MRI showed massive meningeal enhancement in the left frontal lobe, which progressively enlarged. The patient's clinical condition deteriorated and a second craniotomy was performed with complete removal of the secondary tumour, which was shown to be a malignant meningioma. Immunohistochemical staining identified CD133-positive cells in both tumours. A rare fraction of brain tumour stem cells (BTSC) was isolated from the primary astrocytoma using a serum-free culture system, suggesting that BTSC may have been involved in the rapid emergence of RIM after resection and radiation of the primary astrocytoma.

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“…Prospective assessment of cognitive functions was not performed in the great majority of the studies. Although the incidence of second brain tumors after pituitary irradiation is low, literature studies [29][30][31][32] have reported a cumulative risk of developing a second brain tumor in patients harboring pituitary adenomas, when treated with radiotherapy. In fact, in a recent study, Minniti et al reported that an increased risk of second brain tumors goes beyond 20-30 years after treatment.…”

Section: Discussionmentioning

confidence: 99%