Magnetic resonance imaging in childhood leukemia survivors treated with cranial radiotherapy: A cross sectional, single center study

Faraci, Maura; Morana, Giovanni; Bagnasco, Francesca; Barra, Salvina; Polo, Paola; Hanau, Guia; Fioredda, Francesca; Caruso, Silvia; Rossi, Andrea; Spaziante, Renato; Haupt, Riccardo

doi:10.1002/pbc.22923

Cited by 25 publications

(20 citation statements)

References 26 publications

(41 reference statements)

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“…[18][19][20][21][22][37][38][39][40][41] In our study, a considerable number of survivors with LE (n = 58/163, 36%) had CNS LE and this is comparable with the study by Smedler et al 22 and one study reported that 11 of 13 (85%) patients transplanted before age 3 with TBI had neuropsychological abnormalities. 11 In the study by Leung et al, 10 two of seven infant leukaemia patients with cranial irradiation (CRT/TBI) and HSCT developed a seizure disorder.…”

Section: Discussionsupporting

confidence: 93%

Incidence and severity of crucial late effects after allogeneic HSCT for malignancy under the age of 3 years: TBI is what really matters

Bresters

Lawitschka

Cugno

et al. 2016

Bone Marrow Transplant

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Younger children are considered to be more vulnerable to late effects (LE), which prompted us to study LE in patients after haematopoietic stem cell transplantation (HSCT) for a haematological malignancy before the age of 3. In this multicentre EBMT study, cumulative incidence (CI) and severity of endocrine LE, central nervous system complications and secondary malignancies at 5, 10, 15 and 20 years of follow-up were assessed. Risk factors (RF) like gender, diagnosis, age at and year of HSCT, TBI- or chemo-conditioning and GVHD were analysed. CI of any LE was 0.30, 0.52, 0.66 and 0.72 at 5, 10, 15 and 20 years after HSCT, respectively. In 25% of the patients, LE were severe at a median follow-up of 10.4 years. In multivariate analysis, only TBI was a RF for having any LE and for thyroid dysfunction and growth disturbance. Female gender was a RF for delayed pubertal development. Some more insight could be gained by descriptive analysis regarding the role of TBI and GVHD on the severity of LE. Although only five selected LE have been studied and median follow-up is relatively short, the incidence and severity of these LE are considerable but not different from what has been found in older children and TBI is the main RF.

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Section: Discussionsupporting

confidence: 93%

Incidence and severity of crucial late effects after allogeneic HSCT for malignancy under the age of 3 years: TBI is what really matters

Bresters

Lawitschka

Cugno

et al. 2016

Bone Marrow Transplant

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“…Others report an inverse relationship, finding that ICMs occur more commonly at the lower dose rim of the radiation field 5, 11 . Regardless, it appears that low+dose radiation is sufficient to induce ICMs, as children with leukemia, who are treated with relatively low doses of radiation (12+24 Gy), are also at increased risk for developing ICMs 11, 12 .…”

Section: Introductionmentioning

confidence: 99%

Rates and Characteristics of Radiographically Detected Intracerebral Cavernous Malformations After Cranial Radiation Therapy in Pediatric Cancer Patients

et al. 2014

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Rates and characteristics of intracerebral cavernous malformations (ICMs) after cranial radiation therapy (CRT) remain poorly understood. Herein we report on ICMs detected on follow+up imaging in pediatric cancer patients who received CRT at age ≤ 18 years from 1980 to 2009. Through chart reviews (n=362) and phone interviews (n=104) of a retrospective cohort we identified 10 patients with ICMs. The median latency time for detection of ICMs after CRT was 12 years (range 1+24 years) at a median age of 21.4 years (IQR 15+28). The cumulative incidence was 3% (95% CI 1+8%) at 10 years post CRT and 14% (95% CI 7+26%) at 15 years. Three patients underwent surgical resection. Two surgical specimens were pathologically similar to sporadically occurring ICMs; one was consistent with capillary telangiectasia. ICMs are common after CRT and can show a spectrum of histological features.

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“…10,13 In a previous study of 6 patients who received cranial irradiation for leukemia (3 patients), pontine glioma (1 patient), MB (1 patient), or cerebellar astrocytoma (1 patient), symptomatic FHDs requiring surgery developed in 3 patients (2 with leukemia and 1 with cerebellar astrocytoma). 16 In our cohort consisting only of RT-treated MB patients, none of the FHDs resulted in symptomatic hemorrhage that required surgical intervention.…”

Section: Discussionmentioning

confidence: 99%

“…In addition, since Gaensler et al 11 and Poussaint et al 23 first described the features of the these lesions, an increase in the number of survivors of childhood cancers has resulted in an increase of lesion detection on routine MRI scans. The incidence of these lesions reported in the literature now ranges from 2.6%-57%, 4,10,13,15,17 and its wide range is likely attributable to different diagnostic methods, heterogeneous underlying diseases, and therapies (chemotherapy and radiation field and dose). Studies have suggested a higher incidence of these lesions among children, 13,21 particularly after treatment of MB, 17,21 and this was confirmed in the present study, which showed that 80% of patients treated for MB showed FHDs, 94% of whom had multiple lesions.…”

Section: Discussionmentioning

confidence: 99%

Increased focal hemosiderin deposition in pediatric medulloblastoma patients receiving radiotherapy at a later age

Yeom¹,

Lober²,

Partap

et al. 2013

PED

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Object Focal hemosiderin deposition (FHD) is commonly observed on brain MRI scans of patients treated for childhood medulloblastoma (MB). The authors sought to determine the clinical significance of FHD and its relationship to patient age, radiation dose, and cognitive outcomes. Methods A single-institution retrospective study of 93 MB patients at Lucile Packard Children's Hospital at Stanford from 1998 to 2011 identified 41 patients with a negative baseline MRI scan and at least 2 posttreatment MRI scans obtained with T2* gradient recalled echo (GRE). The number and cumulative rate of FHDs detectable by GRE were compared between patients aged 6 years and younger (early age) and aged 7–21 years (late age) at the time of radiotherapy (RT) and between low-dose (1800–2340 cGy) and high-dose (2920–3960 cGy) RT. Results The median age at MB diagnosis was 7.3 years (range 0.9–21.0 years), the median clinical follow-up period was 5.8 years (range 0.8–13.4 years), and the median 5-year overall survival was 81% ± 7%. Of 30 school-aged children with MB, 21 (70%) required special education, and the median IQ of 10 tested patients was 100 (range 50–118). Thirty-three patients (80%) had FHD after a median latency of 1.9 years (range 0.1–5.9 years). Ninety-four percent (436 of 466) of the lesions arose in the supratentorial region of the brain, whereas 29 (6%) resided in the brainstem or the cerebellum. No spinal lesions were observed on routine spine MRI scans using T2 fast spin echo imaging. The mean cumulative lesion rate per year was 2.23 ± 3.05, and this rate was higher in older children at the time of RT compared with younger children (3.23 vs 0.67 per year, p = 0.002) but did not differ among different RT doses (p = 0.395). A child's IQ or need for special education showed no significant correlation with the rate of lesion development or number of lesions. None of the lesions resulted in symptomatic hemorrhage that required surgical intervention. Conclusions More FHD was observed in children treated for MB at the older ages than in those treated at the younger ages. There was no significant association of the incidence of FHD with radiation dose or cognitive outcomes, and none of the lesions required surgical intervention.

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Magnetic resonance imaging in childhood leukemia survivors treated with cranial radiotherapy: A cross sectional, single center study

Cited by 25 publications

References 26 publications

Incidence and severity of crucial late effects after allogeneic HSCT for malignancy under the age of 3 years: TBI is what really matters

Incidence and severity of crucial late effects after allogeneic HSCT for malignancy under the age of 3 years: TBI is what really matters

Rates and Characteristics of Radiographically Detected Intracerebral Cavernous Malformations After Cranial Radiation Therapy in Pediatric Cancer Patients

Increased focal hemosiderin deposition in pediatric medulloblastoma patients receiving radiotherapy at a later age

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