Radiation-induced brain tumours after central nervous system irradiation in childhood: a review

Pettorini, Benedetta; Park, Young-Soo; Caldarelli, Massimo; Massimi, Luca; Tamburrini, Gianpiero; Rocco, Concezio Di

doi:10.1007/s00381-008-0631-7

Cited by 105 publications

(74 citation statements)

References 85 publications

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“…[1][2][3][4][5] The cranial irradiation, especially the radiation dose and the field size, is known as the significant risk factor for developing second brain neoplasms. 1,[6][7][8][9][10][11] However, details of this relationship are still not clear. The mechanisms of the tumour induction are complex.…”

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confidence: 99%

Second brain tumors following central nervous system radiotherapy in childhood

Chojnacka¹,

Pędziwiatr²,

Skowrońska‐Gardas³

et al. 2014

BJR

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Objective: The second tumour (ST) occurrence is a relatively uncommon late complication of radiotherapy but represents one of the most significant issues, especially in childhood oncology. We describe our experience with patients who developed second brain neoplasm following cranial irradiation in childhood. Methods: We identified nine patients who received radiotherapy owing to central nervous system tumour in childhood and subsequently developed the second brain tumour. The full clinical and radiological documentation and histopathological reports were reviewed. Risk factors such as age at irradiation, latency period to ST diagnosis, radiotherapy doses and volumes and other therapy methods were evaluated. We correlated the ST location with the three levels of irradiation dose (high, .40 Gy; medium, 25-40 Gy; and low ,25 Gy).Results: Five meningiomas and four gliomas occurred as the ST after the mean time of 11.7 years after radiotherapy. The average age of children during irradiation was 4.6 years. The shorter latency time to the ST induction was found in children treated with chemotherapy (9 years vs 17.2 years). Seven STs developed in the area of high and moderate dose (.25 Gy), only two low-grade gliomas appeared in the low-dose region. Conclusion: Our data suggest that the STs usually develop in the brain tissues that received doses .25 Gy in patients irradiated at a young age. Advances in knowledge: The low-dose volume seems not to be so significant for second brain neoplasm induction. Therefore, the modern intensity-modulated radiotherapy technique could be safely applied in paediatric patients.

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confidence: 99%

Second brain tumors following central nervous system radiotherapy in childhood

Chojnacka¹,

Pędziwiatr²,

Skowrońska‐Gardas³

et al. 2014

BJR

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“…Hypotheses regarding the formation of intracranial tumors induced by radiation therapy have been confirmed in specific cases of glioblastoma, meningioma, sarcoma, astroma and ependymoma (20)(21)(22)(23). Additionally, there are reports regarding the development of intracranial tumors, such as meningiomas (24,25), primitive neuroectodermal tumors (26), gliomas (20,27) and ependymomas (28) in response to radiation therapy for pituitary adenoma.…”

Section: Discussionmentioning

confidence: 96%

Prolactinoma associated with an ependymoma in the fourth ventricle: A case report and review of the literature

Yang

et al. 2015

Oncology Letters

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Abstract. Pituitary adenoma associated with ependymoma in the fourth ventricle is a rare condition. In the present study, a 46-year-old man diagnosed with prolactinoma, who previously underwent two surgical procedures (one for the removal of a primary tumor and a second following its recurrence) developed a complication of ependymoma in the fourth ventricle. The presence of the ependymoma was confirmed by pathological analysis and the patient recovered well following two-phase surgical resection of the two tumors. The present study compared the probable cause of concurrent pituitary adenoma and ependymoma within the fourth ventricle with previous relevant studies. These comparisons were used to propose possible genomic and endocrine contributions for the development of the ependymoma from the pituitary adenoma.

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“…Between 30-50% of HGG are found within the cerebral hemispheres, with the rest developing from structures like the thalamus, hypothalamus and basal ganglia [10]. Very rarely do these neoplasms originate in infratentorial structures or the spinal cord.…”

Section: Discussionmentioning

confidence: 99%

“…There are several associations between the development of these types of tumors and rare inherited tumor predisposition syndromes such as Li Fraumeni syndrome, Neurofibromatosis type I, and Turcott syndrome. There are no other known risk factors to development of HGG outside of prior radiation exposure [6,10,18,20].…”

Section: Introductionmentioning

confidence: 99%

Immediate Induction and Consolidation Therapy May Improve Outcomes for Patients with Anaplastic Astrocytoma: a Case Series

Santoro

Kanter²

2014

AJMSM

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Despite advances in chemotherapy and radiation, prognosis for all patients with high grade gliomas remains poor. In anaplastic astrocytomas (WHO III) GTR is associated with a 5 year progression free survival (PFS) of 44% compared to 22% when surgical resection is sub-total. While initial studies demonstrated post-radiation chemotherapy improved outcomes, successive chemotherapeutic trials were unable to significantly improve outcomes. Recent trials in adults with recurrent glioblastoma multiforme have shown that the combination of Bevacixumab and Irinotecan have improved 6 month PFS was 46% and overall survival (OS) at 6 months of 77%. Although these adult studies were encouraging, results were not replicated in children with similar pathology. This case series presents two pediatric patients with anaplastic astrocytoma treated with an induction therapy of Temozolamide (90mg/m2 x 42 days) plus standard radiation therapy (5400 cGy) very shortly after surgical resection, followed by a consolidation treatment regimen of 8-cycles of chemotherapy with Bevacizumab (10mg/m2) and Irinotecan (125mg/m2), given on days 1 and 15 of 21 day cycles. These patients did extraordinarily well on this therapeutic regimen, surpassing expectations, with one patient having 18 months of PFS and one patient achieving CR1 at the time of this publication for 20 months. The treatment regimen was well tolerated without unanticipated toxicities or episodes of severe neutropenia induced by this therapy. We are encouraged by the improvements in PFS and OS in these two patients as well as the acceptability of toxicity in this case series and thus recommend prompt induction and consolidation chemotherapy following resection of these neoplasms.

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Radiation-induced brain tumours after central nervous system irradiation in childhood: a review

Abstract: Paediatric radiation-induced brain tumours differ from the adult counterpart for both the histological subtypes. These figures indicate a specific vulnerability of the infantile brain demonstrated by the most frequent occurrence of highly malignant lesions.

Cited by 105 publications

References 85 publications

Second brain tumors following central nervous system radiotherapy in childhood

Second brain tumors following central nervous system radiotherapy in childhood

Prolactinoma associated with an ependymoma in the fourth ventricle: A case report and review of the literature

Immediate Induction and Consolidation Therapy May Improve Outcomes for Patients with Anaplastic Astrocytoma: a Case Series

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