Late aggressive meningioma following prophylactic cranial irradiation for acute lymphoblastic leukaemia

Abstract

The clinical, radiological and pathological findings in a 28-year-old female patient who developed aggressive meningioma 20 years after prophylatic cranial irradiation (PCI) for acute lymphoblastic leukaemia (ALL) are described here. Only four cases of late atypical/aggressive meningioma following PCI were detected in a thorough search of the literature. The high cure rate in childhood ALL, attributable to aggressive chemotherapy and PCI, is capable of inducing secondary brain tumour, including aggressive meningioma.

Low incidence of second neoplasms among children diagnosed with acute lymphoblastic leukemia after 1983

“…An increased risk of brain tumors has been observed among long-term survivors of childhood ALL. 10,11,14,19,[23][24][25][26][27][28][29][30][31]49 Similar to previous studies, brain tumors were more likely to develop among patients who had received radiation, and the risk increased with increasing radiation dose. 10,11,14 Previous studies reported increased risk of brain tumors among patients who were less than 5 years old at the time of radiation.…”

“…Other commonly reported second neoplasms in this population include lymphoma, acute myeloid leukemia (AML), and thyroid cancer. 10,11,13,14,[18][19][20][21][22][23][24][25][26][27][28][29][30][31] However, most reports of second neoplasms are limited by relatively few patients treated on contemporary riskbased therapeutic protocols and observed for reasonable lengths of time. To address these concerns, we followed a cohort of 8831 children who had been treated on 1 of the 12 Children's Cancer Group (CCG) therapeutic protocols between 1983 and 1995 and had accrued 54 883 person-years of follow-up.…”

Radiation-Induced Meningioma following Prophylactic Radiotherapy for Acute Lymphoblastic Leukemia in Childhood

“…In general, radiation-induced meningiomas have been reported following low-dose irradiation, but they can also occur after higher doses. In these cases, radiation was used for tinea capitis, cranial tumors and hematologic diseases [3, 9]. Furthermore, incidences of meningiomas among the Nagasaki and Hiroshima atomic bomb survivors, as well as after dental X-ray examination, have also been reported [9, 19, 20].…”

Intracranial meningiomas in individuals under the age of 30; Analysis of risk factors, histopathology, and recurrence rate

“…The life expectancy of lung cancer patients, both small-cell and non-small-cell, may be shorter than the latency period for the development of an intracranial tumor and hence, this patient population is rarely considered in this context. On the other hand, children with ALL who receive prophylactic cranial radiation at a young age, frequently in the first decade of life, are uniquely susceptible to developing intracranial tumors such as meningiomas as they have excellent long-term survival with current chemotherapy and radiation therapy treatments [27][28][29]. In addition, arachnoidal tissues in children may be uniquely susceptible to the oncogenic effects of ionizing radiation [25].…”

“…The CNS, and testes in males, is considered a sanctuary site that is relatively impermeable to the effects of systemic chemotherapy. Involvement of the CNS is seen in 3% of patients at initial presentation and without prophylactic treatment, most high risk patients will develop CNS disease [14,15,[27][28][29][41][42][43][45][46][47]. Patients who receive prophylactic cranial irradiation for ALL have a lifetime relative risk of developing a RIM or other intracranial tumor due to the long survival effected by the treatment of the primary malignancy [15].…”