© Copyright 2009 by the Society for Neuro-Oncology
Received July 7, 2008
Accepted November 26, 2008
Radiation-induced meningiomas: A shadow in the success story of childhood leukemia
Joanna Banerjee 1,
Eija Pääkkö 2,
Marika Harila 1,
Riitta Herva 3,
Juho Tuominen 4,
Antero Koivula 5,
Marjatta Lanning 1,
Arja Harila-Saari 6*
1 Department of Pediatrics, University Hospital of Oulu, Oulu, Finland
2 Department of Radiology, University Hospital of Oulu, Oulu, Finland
3 Department of Pathology, University Hospital of Oulu, Oulu, Finland
4 Department of Neurosurgery, University Hospital of Oulu, Oulu, Finland
5 Departments of Oncology and Radiotherapy, University Hospital of Oulu, Oulu, Finland
6 Department of Pediatrics, University Hospital of Oulu, Oulu, Finland; P.O. Box 23, Oulu 90029, Finland
* To whom correspondence should be addressed. E-mail: arja.harila-saari{at}oulu.fi.
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Abstract |
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While the prognosis of acute childhood leukemia has improved, long-term survivors are increasingly experiencing late effects of the treatment. Cranially irradiated survivors are predisposed to the development of central nervous system tumours. Our aim was to describe the incidence of secondary brain tumours and to define the significance of treatment-related risk factors and host characteristics in a cohort of childhood leukemia survivors. Our cohort consisted of 60 consecutive cranially irradiated adult survivors of childhood leukemia treated in Oulu University Hospital. MRI of the brain was performed on 49 of them. The sites of the tumours, their histology and details of the leukemia treatment were determined. Of the 49 patients, eleven (22%) aged 1-8 years at the time of diagnosis developed meningioma, while no other brain tumours were seen. In this cohort, the development of meningioma seemed to show undisputable linkage with long latency periods (mean 25 years, range 14-34 years) and an increasing incidence 20 years after the treatment (47%). Three patients had multiple meningiomas, two had recurrent disease, and one had an atypical meningioma. Age at the time of irradiation, gender or cumulative doses of chemotherapeutic agents showed no significant association with the development of meningiomas. The high incidence of meningiomas in this study was associated with long follow-up periods. Although the cohort is small, it looks probable that the increasing incidence of meningioma will shadow the future of cranially irradiated leukemia survivors. Systematic brain imaging after the treatment is therefore justifiable.
Key Words:
acute leukemia, brain tumor, cranial radiation therapy, meningioma, second neoplasm
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