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Extraneural Metastasis of Primary Glioma Occurring in a Setting of Occupational Ionizing Radiation Exposure. Case Rep Neurol Med 2019; 2019:1748739. [PMID: 31312534 PMCID: PMC6595336 DOI: 10.1155/2019/1748739] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 05/29/2019] [Indexed: 11/29/2022] Open
Abstract
Malignant gliomas account for 60% of all primary brain tumors in adults. Glioblastoma Multiforme (GBM) is the most common primary glial tumor with a dismal prognosis and a median survival of approximately 14 months. Extra-neural metastases from primary brain tumors are unusual with an incidence rate of less than 2%. This has been attributed to factors such as short survival, lack of true lymphatics in the CNS, and physical barriers provided by the dura, extracellular matrix, and basement membrane. Although most GBMs occur sporadically, there is a known association with therapeutic radiation exposure and with work in nuclear disaster cleanup. To our knowledge, no case of GBM with metastasis occurring in a patient with occupational radiation exposure currently exists in the literature. In this article, we present a case of GBM with lung metastasis occurring in a 51-year-old Caucasian male, whose history is significant for occupational exposure to ionizing radiation, and review the literature on GBM risk factors and potential mechanisms of metastasis.
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Abstract
Aims and background Radiotherapy is important in the treatment of neoplasm of the central nervous system, but various side effects, particularly neoplastic, have been described. Recently, post-radiation gliomas have been reported. Methods The authors review 88 cases of cerebral glioma following radiotherapy in patients operated for neoplasms of the nervous system, including 6 personal cases of post-radiation gliomas treated in the Neurosurgical Division of the Department of Neurological Sciences, “La Sapienza” University, Rome. The criteria used to define this unusual pathologic association are discussed. Results There was a male predominance. Post-radiation gliomas were particularly malignant, the average dose was 33 Gy, and average free latency was 9.6 years. The first disease was most frequently acute lymphatic leukemia. Conclusions Post-radiation gliomas have particular features but do not present a histologic or clinical behavior different from analogous spontaneous gliomas. The fact that 88 cases have been reported in recent years suggests that a thorough biological, clinical studies be carried out on this association.
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Affiliation(s)
- M Salvati
- Department of Neurological Sciences, Neurosurgery, La Sapienza University of Rome, Italy
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3
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Yamanaka R, Hayano A, Kanayama T. Radiation-induced gliomas: a comprehensive review and meta-analysis. Neurosurg Rev 2016; 41:719-731. [DOI: 10.1007/s10143-016-0786-8] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Revised: 08/25/2016] [Accepted: 09/19/2016] [Indexed: 10/20/2022]
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4
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Yamanaka R, Hayano A. Secondary glioma following acute lymphocytic leukemia: therapeutic implications. Neurosurg Rev 2016; 40:549-557. [DOI: 10.1007/s10143-016-0733-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Revised: 02/16/2016] [Accepted: 03/13/2016] [Indexed: 10/21/2022]
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Yoon SI, Park KJ, Park DH, Kang SH, Park JY, Chung YG. World Health Organization Grade II Oligodendroglioma Occurring after Successful Treatment for Childhood Acute Lymphoblastic Leukemia. Brain Tumor Res Treat 2016; 4:145-149. [PMID: 27867928 PMCID: PMC5114188 DOI: 10.14791/btrt.2016.4.2.145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Revised: 07/14/2016] [Accepted: 09/22/2016] [Indexed: 11/20/2022] Open
Abstract
When treating childhood acute lymphoblastic leukemia (ALL), secondary neoplasms are a significant long term problem. Radiation is generally accepted to be a major cause of the development of secondary neoplasms. Following treatment for ALL, a variety of secondary tumors, including brain tumors, hematologic malignancies, sarcomas, thyroid cancers, and skin cancers have been reported. However, oligodendroglioma as a secondary neoplasm is extremely rare. Herein we present a case of secondary oligodendroglioma occurring 13 years after the end of ALL treatment.
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Affiliation(s)
- Sang-In Yoon
- Department of Neurosurgery, Korea University Anam Hospital, College of Medicine, Korea University, Seoul, Korea
| | - Kyung-Jae Park
- Department of Neurosurgery, Korea University Anam Hospital, College of Medicine, Korea University, Seoul, Korea
| | - Dong-Hyuk Park
- Department of Neurosurgery, Korea University Anam Hospital, College of Medicine, Korea University, Seoul, Korea
| | - Shin-Hyuk Kang
- Department of Neurosurgery, Korea University Anam Hospital, College of Medicine, Korea University, Seoul, Korea
| | - Jung-Yul Park
- Department of Neurosurgery, Korea University Anam Hospital, College of Medicine, Korea University, Seoul, Korea
| | - Yong-Gu Chung
- Department of Neurosurgery, Korea University Anam Hospital, College of Medicine, Korea University, Seoul, Korea
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6
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Elsamadicy AA, Babu R, Kirkpatrick JP, Adamson DC. Radiation-Induced Malignant Gliomas: A Current Review. World Neurosurg 2015; 83:530-42. [DOI: 10.1016/j.wneu.2014.12.009] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2014] [Revised: 09/30/2014] [Accepted: 12/09/2014] [Indexed: 01/07/2023]
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7
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The etiology of low-grade gliomas: pathological and clinical considerations about radiation-induced low-grade gliomas. Neurol Sci 2015; 36:1091-5. [PMID: 25749546 DOI: 10.1007/s10072-015-2136-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Accepted: 02/25/2015] [Indexed: 10/23/2022]
Abstract
The only environmental factor undoubtedly linked to an increased risk of brain tumors (including gliomas) is therapeutic X-rays. We aim to conduct a detailed study of radiation-induced low-grade gliomas, in order to better understand the pathogenesis of such gliomas. Furthermore, we want do prove whether or not there are significant differences, according to clinical features and biological behavior, between this type of tumor and general low-grade gliomas. We analyzed the existent literature of low-grade radiation-induced glioma case reports and other epidemiological reports based on the experience of the senior author. We were able to collect 20 cases of such gliomas. Demographic data and previous X-ray details, along with latency intervals of all patients are provided. The amount of radiation able to cause mutations is not necessarily very high, as tumors occur even after low doses of radiation (as 3-5 GY). The incidence of this kind of tumors may be underestimated and may rise in the future. Care must be taken when observing patients who were irradiated more than 10 years before, especially in the recent years in which access to radiosurgical and radiation therapies has increased in the general population for treating many cerebral pathologies. Radiation-induced low-grade gliomas appear to be different from general gliomas only in terms of age in which they occur. In terms of clinical and biological behavior, there seem to be no differences, even though exceptional cases are reported.
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8
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Chowdhary A, Spence AM, Sales L, Rostomily RC, Rockhill JK, Silbergeld DL. Radiation associated tumors following therapeutic cranial radiation. Surg Neurol Int 2012; 3:48. [PMID: 22629485 PMCID: PMC3356990 DOI: 10.4103/2152-7806.96068] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2011] [Accepted: 04/11/2012] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND A serious, albeit rare, sequel of therapeutic ionizing radiotherapy is delayed development of a new, histologically distinct neoplasm within the radiation field. METHODS We identified 27 cases, from a 10-year period, of intracranial tumors arising after cranial irradiation. The original lesions for which cranial radiation was used for treatment included: tinea capitis (1), acute lymphoblastic leukemia (ALL; 5), sarcoma (1), scalp hemangioma (1), cranial nerve schwannoma (1) and primary (13) and metastatic (1) brain tumors, pituitary tumor (1), germinoma (1), pinealoma (1), and unknown histology (1). Dose of cranial irradiation ranged from 1800 to 6500 cGy, with a mean of 4596 cGy. Age at cranial irradiation ranged from 1 month to 43 years, with a mean of 13.4 years. RESULTS Latency between radiotherapy and diagnosis of a radiation-induced neoplasm ranged from 4 to 47 years (mean 18.8 years). Radiation-induced tumors included: meningiomas (14), sarcomas (7), malignant astrocytomas (4), and medulloblastomas (2). Data were analyzed to evaluate possible correlations between gender, age at irradiation, dose of irradiation, latency, use of chemotherapy, and radiation-induced neoplasm histology. Significant correlations existed between age at cranial irradiation and development of either a benign neoplasm (mean age 8.5 years) versus a malignant neoplasm (mean age 20.3; P = 0.012), and development of either a meningioma (mean age 7.0 years) or a sarcoma (mean age 27.4 years; P = 0.0001). There was also a significant positive correlation between latency and development of either a meningioma (mean latency 21.8 years) or a sarcoma (mean latency 7.7 years; P = 0.001). The correlation between dose of cranial irradiation and development of either a meningioma (mean dose 4128 cGy) or a sarcoma (mean dose 5631 cGy) approached significance (P = 0.059). CONCLUSIONS Our study is the first to show that younger patients had a longer latency period and were more likely to have lower-grade lesions (e.g. meningiomas) as a secondary neoplasm, while older patients had a shorter latency period and were more likely to have higher-grade lesions (e.g. sarcomas).
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Affiliation(s)
- Abhineet Chowdhary
- Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
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Nakamura H, Makino K, Ushio Y, Arima R, Kuratsu JI. Therapy-associated secondary tumors in patients with non-germinomatous malignant germ cell tumors. J Neurooncol 2011; 105:359-64. [PMID: 21533838 DOI: 10.1007/s11060-011-0597-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2010] [Accepted: 04/20/2011] [Indexed: 11/30/2022]
Abstract
We report three patients with non-germinomatous malignant germ cell tumor (NGMGCT) who developed therapy-associated secondary tumors. They were diagnosed as having NGMGCT by elevated serum levels of α-fetoprotein (AFP), human chorionic gonadotropin (HCG), or β-HCG. Preoperatively, all patients received a combination of etoposide and platinum-based chemotherapy and radiotherapy; neo-adjuvant therapy (NAT) was followed by complete excision of the residual tumor. Postoperatively, all underwent maintenance chemotherapy and all remained free of NGMGCT without recurrence. However, they developed therapy-associated secondary tumors, i.e. glioblastoma, meningioma, or cavernous angioma after 10.1, 9.8, and 8.2 years, respectively. The patient with glioblastoma died one year after its detection. The other two patients are currently alive; the meningioma was completely removed and the cavernous angioma is being monitored without additional treatment. To the best of our knowledge, therapy-associated secondary tumors in patients treated for NGMGCT are rare.
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Affiliation(s)
- Hideo Nakamura
- Department of Neurosurgery, Graduate School of Life Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto, 860-8556, Japan.
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10
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KOMATSU F, KAWAGUCHI H, TSUGU H, OSHIRO S, KOMATSU M, FUKUSHIMA T, NABESHIMA K, INOUE T. Radiation-Induced Astrocytoma With Rapid Malignant Transformation -Case Report-. Neurol Med Chir (Tokyo) 2011; 51:243-6. [DOI: 10.2176/nmc.51.243] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Fuminari KOMATSU
- Department of Neurosurgery, Faculty of Medicine, Fukuoka University
| | | | - Hitoshi TSUGU
- Department of Neurosurgery, Faculty of Medicine, Fukuoka University
| | - Shinya OSHIRO
- Department of Neurosurgery, Faculty of Medicine, Fukuoka University
| | - Mika KOMATSU
- Department of Neurosurgery, Faculty of Medicine, Fukuoka University
| | - Takeo FUKUSHIMA
- Department of Neurosurgery, Faculty of Medicine, Fukuoka University
| | - Kazuki NABESHIMA
- Department of Pathology, Faculty of Medicine, Fukuoka University
| | - Tooru INOUE
- Department of Neurosurgery, Faculty of Medicine, Fukuoka University
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Salvati M, D'Elia A, Melone GA, Brogna C, Frati A, Raco A, Delfini R. Radio-induced gliomas: 20-year experience and critical review of the pathology. J Neurooncol 2008; 89:169-77. [PMID: 18566750 DOI: 10.1007/s11060-008-9565-x] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2007] [Accepted: 02/25/2008] [Indexed: 11/25/2022]
Affiliation(s)
- Maurizio Salvati
- Department of Neurosurgery, INM Neuromed IRCCS, Pozzilli, Is, Italy.
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12
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Diagnostic and therapeutic challenges owing to concurrent pontine glioma and acute lymphoblastic leukemia. J Pediatr Hematol Oncol 2008; 30:454-7. [PMID: 18525463 DOI: 10.1097/mph.0b013e318161aa4e] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The presence of 2 active primary tumors in a child is both unusual and challenging. This places the clinician and the family in a difficult situation while planning the treatment. The concurrent presence of a low-grade brain stem glioma and acute lymphoblastic leukemia in a genetically normal girl is presented. The problems encountered with diagnosis and treatment are discussed here.
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Tanriover N, Ulu MO, Sar M, Uzan M. Anaplastic oligoastrocytoma: previous treatment as a possible cause in a child with acute lymphoblastic leukemia. Childs Nerv Syst 2007; 23:469-73. [PMID: 17043901 DOI: 10.1007/s00381-006-0246-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2006] [Revised: 07/08/2006] [Indexed: 11/27/2022]
Abstract
INTRODUCTION The authors present a 14-year-old patient who developed an anaplastic oligoastrocytoma of the left parietal lobe 9 years after a successful treatment of acute lymphoblastic leukemia (ALL). He had a history of induction chemotherapy, intrathecal methotrexate and prophylactic whole brain irradiation (1,800 cGy in 10 fractions over 2 weeks). DISCUSSION Radiation-induced neoplasia is suggested to be the late complication of ALL treatment, and evaluation of large clinical series revealed a relationship between young age at ALL diagnosis (<6 years) and increased high-grade glioma occurrence risk. CONCLUSION The authors have reviewed previously reported cases of secondary central nervous system malignancies focusing on age at ALL diagnosis, and they think that synergistic action of therapeutic modalities could have played a role in the oncogenetic process. Detailed systematic radiological follow-up should be done in these patients especially if a personal history of cranial irradiation is present.
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Affiliation(s)
- Necmettin Tanriover
- Department of Neurosurgery, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey.
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14
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Vancura RW, Kepes JJ, Newell KL, Ha TM, Arnold PM. Secondary intracranial neoplasms exhibiting features of astrocytoma and neuroblastoma in 2 children treated for acute lymphoblastic leukemia: report of 2 cases. ACTA ACUST UNITED AC 2006; 65:490-4. [PMID: 16630913 DOI: 10.1016/j.surneu.2005.06.047] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2005] [Accepted: 06/28/2005] [Indexed: 11/24/2022]
Abstract
With the advent of more aggressive antineoplastic combination chemotherapies, agents with fewer adverse effects, prophylactic central nervous system radiation treatments, and more efficacious antibiotics, the number of childhood cancer survivors is continually increasing. These patients place a new responsibility on clinicians; systematic follow-up with effective intervention is necessary to reduce the consequences of the treatments themselves. We report 2 patients who were diagnosed with pre-B-cell acute lymphoblastic leukemia and later presented with intracranial malignancies. Both patients were treated with radiation and with similar chemotherapeutic regimens. Each patient was in remission for leukemia at the time of diagnosis of the second malignancy. The possible causes of the brain tumors in association with acute lymphoblastic leukemia are discussed.
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Affiliation(s)
- Ryan W Vancura
- Department of Biology, University of Kansas Medical Center, Kansas City, KS 66160, USA
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15
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Salvati M, Frati A, Russo N, Caroli E, Polli FM, Minniti G, Delfini R. Radiation-induced gliomas: report of 10 cases and review of the literature. SURGICAL NEUROLOGY 2003; 60:60-7; discussion 67. [PMID: 12865017 DOI: 10.1016/s0090-3019(03)00137-x] [Citation(s) in RCA: 94] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Radiotherapy and more recently radiosurgery represent important therapeutic methods for the treatment of tumors and arterovenous malformations affecting the central nervous system, even though several significant side-effects have been described (radionecrosis, tumors, etc.). Gliomas induced by radiation therapy are decidedly unusual, and the first descriptions of this association only appeared in the 1960s. METHODS The pertinent literature was reviewed to yield 116 cases in which a glioma developed after radiotherapy for cranial pathologies (included 10 personal cases treated in our Institution). One of our patients had undergone radiosurgery for a cavernous angioma. RESULTS Patients who developed a radiation-induced glioma were younger, as a group, than those affected with so-called "spontaneous" gliomas. The tumor originated in the previously irradiated area, after average doses of 32 Gy and an average latency period of 9.6 years in accordance with the findings reported by the authors and in our experience as well. Radiotherapy had most frequently been performed for acute lymphoblastic leukemia. Our Case 10 is the fourth case of intracranial tumor arising after radiosurgery to be described in the literature. CONCLUSIONS Though rare, gliomas may represent a late complication of radiation treatment. The behavior of the radiation-induced variety of glioma does not seem to differ significantly from that of its "spontaneous" counterpart. Late complications of the radiosurgery are probably underestimated because of the relatively recent introduction of this technique. On the contrary, these should be scrupulously evaluated when deciding whether to employ this method for therapeutic purposes for relatively benign or congenital lesions (which generally affect young patients with a long life expectancy).
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Affiliation(s)
- Maurizio Salvati
- Department of Neurosurgery-INM Neuromed, Pozzilli (Is), University of Rome La Sapienza, Via Cardinal Agliardi 15, 00165 Rome, Italy
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Karaüzüm SB, Hazar V, Açikbas I, Gelen T, Yessilipek MA, Lüleci G. Existence of acute lymphoblastic leukemia and osteosarcoma in a child. J Pediatr Hematol Oncol 2002; 24:572-4. [PMID: 12368699 DOI: 10.1097/00043426-200210000-00017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The existence of acute lymphoblastic leukemia (ALL) and osteosarcoma is described. An 8-year-old girl had osteosarcoma diagnosed on radiologic and pathologic examination during ALL maintenance treatment. Cytogenetic analyses in primary cell culture of osteosarcoma tissue from the patient showed complex chromosomal abnormalities including t(1;19), usually seen in B precursor cell ALL, and del 13, found in a great majority of primary osteosarcomas. To show the possibility of the existence of the genetic susceptibility caused by gene rearrangements, we used molecular technique. But we could not determine any association between gene and genetic susceptibility.
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Affiliation(s)
- Sibel Berker Karaüzüm
- Department of Medical Biology and Genetics, Akdeniz University School of Medicine, Antalya, Turkey
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Bhatia S, Sather HN, Pabustan OB, Trigg ME, Gaynon PS, Robison LL. Low incidence of second neoplasms among children diagnosed with acute lymphoblastic leukemia after 1983. Blood 2002; 99:4257-64. [PMID: 12036851 DOI: 10.1182/blood.v99.12.4257] [Citation(s) in RCA: 126] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Second malignant neoplasms are a serious complication after successful treatment of childhood acute lymphoblastic leukemia (ALL). With improvement in survival, it is important to assess the impact of contemporary risk-based therapies on second neoplasms in ALL survivors. A cohort of 8831 children diagnosed with ALL and enrolled on Children's Cancer Group therapeutic protocols between 1983 and 1995 were observed to determine the incidence of second neoplasms and associated risk factors. The median age at diagnosis of ALL was 4.7 years. The cohort had accrued 54 883 person-years of follow-up. Sixty-three patients developed second neoplasms, including solid, nonhematopoietic tumors (n = 39: brain tumors n = 19, other solid tumors n = 20), myeloid leukemia or myelodysplasia (n = 16), and lymphoma (n = 8). The cumulative incidence of any second neoplasm was 1.18% at 10 years (95% confidence interval, 0.8%-1.5%), representing a 7.2-fold increased risk compared with the general population. The risk was increased significantly for acute myeloid leukemia (standardized incidence ratio [SIR] 52.3), non-Hodgkin lymphoma (SIR 8.3), parotid gland tumors (SIR 33.4), thyroid cancer (SIR 13.3), brain tumors (SIR 10.1), and soft tissue sarcoma (SIR 9.1). Multivariate analysis revealed female sex (relative risk [RR] 1.8), radiation to the craniospinal axis (RR 1.6), and relapse of primary disease (RR 3.5) to be independently associated with increased risk of all second neoplasms. Risk of second neoplasms increased with radiation dose (1800 cGy RR 1.5; 2400 cGy RR 3.9). Actuarial survival at 10 years from diagnosis of second neoplasms was 39%. Follow-up of this large cohort that was treated with contemporary risk-based therapy showed that the incidence of second neoplasms remains low after diagnosis of childhood ALL.
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Affiliation(s)
- Smita Bhatia
- City of Hope National Medical Center, Duarte, CA, USA. smason@childrensoncology group.org
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18
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Nagashima T, Mori M, Fujimoto M, Nunomura M, Sakurai Y, Okada Y, Itoh T, Sawa H, Stan AC, Nagashima K. Adult T-cell lymphoma involving the leptomeninges associated with a spinal cord schwannoma. Neuropathology 2001; 21:229-35. [PMID: 11666021 DOI: 10.1046/j.1440-1789.2001.00391.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Adult T-cell lymphoma (ATL-L) developing initially in the meninges is rare. An autopsy case of ATL-L with an acute onset of meningitis and generalized lymphadenopathy in association with a cervical cord schwannoma is reported here. A 78-year-old woman with sensori-motor weakness of both arms over a 1-year period, developed febrile episodes and drowsiness with neck stiffness. Lumbar puncture revealed an increased protein content (161 mg/dL) and increased cell count (463/3) consisting of 99% of lymphocytes which contained atypical lymphocytes with multilobulated nuclei ('flower cells'), which are characteristic of ATL-L. Viral titers were positive only for HTLV-I antibodies (serum X 640: CSF X 16). Biopsy of an enlarged retroperitoneal lymph node revealed malignant lymphoma of the T-cell type. Brain MRI was negative, whereas an intradural extramedullary mass was found at the C4 level. With a diagnosis of ATL-L stage IV, chemotherapy was commenced, which was effective in reducing the generalized lymphadenopathy as well as the cervical mass and restoring the CSF findings to normality. The cervical cord mass was verified to be a solitary schwannoma, and ATL-L involvement was found not only in the leptomeninges, but also within the cervical cord schwannoma.
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Affiliation(s)
- T Nagashima
- Department of Neurology, Teine Keijinkai Hospital, Sapporo, Japan
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Kim AL, Fernandez CV, Greer WL, Hogg D, Lassam NJ, Resch L. Concurrent acute lymphoblastic leukemia and juvenile pilocytic astrocytoma in a pediatric patient. J Pediatr Hematol Oncol 2000; 22:451-3. [PMID: 11037859 DOI: 10.1097/00043426-200009000-00013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The concurrence of acute lymphoblastic leukemia (ALL) and an asymptomatic juvenile pilocytic astrocytoma is described. A 6-year-old boy without clinical evidence of neurofibromatosis had a juvenile pilocytic astrocytoma diagnosed on radiologic examination and before treatment of acute pre-B cell lymphoblastic leukemia. The patient has had a partial resection of the astrocytoma and is 9 months into treatment of his ALL, which is in complete remission. p53 gene mutation was not identified in this patient. The concurrent diagnosis before treatment of ALL and juvenile pilocytic astrocytoma, the latter normally an indolent tumor, suggests that some cases of astrocytoma previously ascribed to radiotherapy or other treatment may in fact be caused by other factors.
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Affiliation(s)
- A L Kim
- QEII Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia, Canada
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20
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Abstract
Brain tumors in children are a diverse group of diseases that require multidisciplinary and subspecialty expertise. Radiation therapy is an established treatment cornerstone for these pediatric tumors. Basic concepts of radiation biology and physics provide a framework for understanding the ongoing evolution in radiation delivery techniques and current treatment paradigms. Standard techniques of pediatric central nervous system radiotherapy are included in this review, as well as newer techniques including conformal therapy, stereotactic radiosurgery, and fractionated stereotactic radiotherapy. Examples are provided to illustrate differences in treatment approaches. The appropriate application of each technique is discussed, and then outcomes and treatment sequelae are compared.
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Affiliation(s)
- J M Buatti
- Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, USA
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21
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Antillon F, Kaste SC, Jenkins JJ, Shurtleff SA, Merchant TE, Downing JR, Pappo AS. Primitive neuroectodermal tumor of bone as a second malignant neoplasm in a child previously treated for acute lymphoblastic leukemia. J Pediatr Hematol Oncol 1997; 19:473-6. [PMID: 9329474 DOI: 10.1097/00043426-199709000-00014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
PURPOSE Although rare, second malignant neoplasms (SMNs) are a devastating consequence of successful treatment of childhood cancer. The 15-year estimated risk of developing a second malignant neoplasm after treatment of childhood acute lymphoblastic leukemia (ALL) is 2.5%. Most of these neoplasms are central nervous system tumors. The risk of secondary acute myeloid leukemia has been negligible in most treatment regimens. Here, we report the first case of a primitive neuroectodermal tumor (PNET) in a patient treated for ALL. PATIENTS AND METHODS A 15.7-year-old girl developed pain in her left leg 7 years after diagnosis of low-risk ALL. Imaging studies revealed lytic lesions in her left proximal tibia and several vertebra as well as metastatic nodules in both lungs. RESULTS Immunocytochemical and molecular analyses led to the diagnosis of PNET. The treatment of this SMN was composed of combination chemotherapy with hematopoietic growth factor support and radiotherapy to the primary lesion and affected spine. The tumor recurred 5 months after the completion of treatment, and the patient is now undergoing salvage therapy composed of chemotherapy and radiotherapy. CONCLUSIONS To our knowledge, this is the first report of PNET as an SMN after successful treatment of ALL.
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Affiliation(s)
- F Antillon
- Department of Hematology-Oncology, St. Jude Children's Research Hospital, Memphis, TN 38105, USA
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22
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Kaschten B, Flandroy P, Reznik M, Hainaut H, Stevenaert A. Radiation-induced gliosarcoma. Case report and review of the literature. J Neurosurg 1995; 83:154-62. [PMID: 7782835 DOI: 10.3171/jns.1995.83.1.0154] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
A 13-year-old boy presented with a cerebral gliosarcoma 12 years after having acute lymphoblastic leukemia treated by chemotherapy and central nervous system prophylaxis treated by radiation therapy (24 Gy) and intrathecal methotrexate. A review of the literature disclosed 129 possible radiation-induced gliomatous and/or sarcomatous brain tumors: namely, 89 gliomas, 36 sarcomas, and four gliosarcomas, including the present case. An analysis of these cases revealed several characteristics that differentiate them from similar spontaneous brain tumors, thus providing arguments for the carcinogenic effect of radiation therapy on intracranial tumors.
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Affiliation(s)
- B Kaschten
- Department of Neurosurgery, University Hospital, University of Liège, Belgium
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23
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Tomlinson FH, Scheithauer BW, Hayostek CJ, Parisi JE, Meyer FB, Shaw EG, Weiland TL, Katzmann JA, Jack CR. The significance of atypia and histologic malignancy in pilocytic astrocytoma of the cerebellum: a clinicopathologic and flow cytometric study. J Child Neurol 1994; 9:301-10. [PMID: 7930411 DOI: 10.1177/088307389400900317] [Citation(s) in RCA: 73] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Biologically malignant pilocytic astrocytomas are rare. Precise morphologic criteria permitting their identification and clinically meaningful distinction from more ordinary pilocytic astrocytomas have not been developed. The histologic grading schemes applied to fibrillary astrocytomas--ones based on nuclear atypia, increased cellularity, mitotic activity, endothelial proliferation, and necrosis--are thought not to correlate with prognosis in pilocytic astrocytomas. Nonetheless, these features were systematically sought in 107 cerebellar pilocytic astrocytomas, four of which were histologically malignant. The clinical, morphologic, and flow cytometric features of these cases were studied. The incidence of histologic malignancy occurring spontaneously in otherwise typical pilocytic astrocytomas was 0.9%; that occurring after radiation was 1.8%. The four histologically malignant tumors occurred in two males and two females, ages 6 to 18 years. All showed increased mitotic activity (three to five mitoses per high-power microscopic field [250x]). Endothelial proliferation and necrosis were present in three and two cases each. DNA ploidy analysis showed the spontaneously occurring malignant-appearing tumors to be aneuploid, whereas both previously radiated tumors were tetraploid; 5% to 11% of cells were in S phase. The appearance of histologic malignancy in pilocytic astrocytoma is rare and less reliably correlated with prognosis than in patients with fibrillary astrocytomas. Essential features of such tumors include a high mitotic index and perhaps a high percentage of cells in S phase.
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Affiliation(s)
- F H Tomlinson
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN 55905
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24
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Iyer RS, Soman CS, Nair CN, Pai SK, Kurkure PA, Pande SC, Advani SH. Brain tumors following cure of acute lymphoblastic leukemia. Leuk Lymphoma 1994; 13:183-6. [PMID: 8025519 DOI: 10.3109/10428199409051670] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
The majority of children with acute lymphoblastic leukemia can be cured with effective modern day therapy. However, more and more long term sequelae including carcinogenic potential of the treatment are being recognised. We report two children who developed acute lymphoblastic leukemia at the age of 4 and 5 years respectively and were successfully treated. They developed meningioma and astrocytoma at 9 and 3 years respectively after completion of therapy. Both were treated surgically and the patient with astrocytoma also received radiotherapy. Both are now free of disease 19 months after diagnosis of second neoplasm.
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Affiliation(s)
- R S Iyer
- Department of Medical Oncology, Tata Memorial Hospital, Parel, Bombay, India
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25
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26
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27
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Zagzag D, Miller DC, Cangiarella J, Allen JC, Greco MA. Brainstem glioma after radiation therapy for acute myeloblastic leukemia in a child with Down syndrome. Possible pathogenetic mechanisms. Cancer 1992; 70:1188-93. [PMID: 1387583 DOI: 10.1002/1097-0142(19920901)70:5<1188::aid-cncr2820700527>3.0.co;2-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
A 13-year-old boy with Down syndrome (DS) had a brainstem glioma confirmed at autopsy, 10 years after receiving prophylactic cranial irradiation for acute myeloblastic leukemia. There is no clear association of brain tumors with DS; despite a reported link between leukemia and glioma, a causal association with radiation therapy is more likely.
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Affiliation(s)
- D Zagzag
- Department of Pathology, New York University Medical Center, NY 10016
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28
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Brüstle O, Ohgaki H, Schmitt HP, Walter GF, Ostertag H, Kleihues P. Primitive neuroectodermal tumors after prophylactic central nervous system irradiation in children. Association with an activated K-ras gene. Cancer 1992; 69:2385-92. [PMID: 1314130 DOI: 10.1002/1097-0142(19920501)69:9<2385::aid-cncr2820690929>3.0.co;2-3] [Citation(s) in RCA: 55] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Three patients had supratentorial malignant brain tumors 7 to 9 years after prophylactic central nervous system (CNS) treatment for acute lymphocytic leukemia or malignant T-cell lymphoma. Therapy was administered at the age of 3 to 8 years and included cranial irradiation (total dose, 1800 to 2400 cGy) and intrathecal methotrexate. The brain tumors had histologic and immunohistochemical features of primitive neuroectodermal tumors (PNET), including neuroblastic rosettes, rhythmic arrangement of tumor cells, and immunohistochemical expression of glial, and in one patient neuronal, marker proteins. Using polymerase chain reaction-mediated DNA amplification from paraffin-embedded tissues and subsequent DNA sequence analysis, an activating point mutation was detected in the K-ras protooncogene in one tumor. This mutation was a G to A transition in position 2 of codon 12, substituting aspartate (GAT) for glycine (GGT). This type of mutation has not been observed before in human brain tumors, but it is frequent in radiation-induced murine lymphomas. These observations suggest that PNET can be induced after completion of the embryonal and fetal development of the human CNS. Oncogene-activating point mutations may represent a pathogenetic mechanism involved in the genesis of radiation-induced brain tumors.
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Affiliation(s)
- O Brüstle
- Laboratory of Neuropathology, Institute of Pathology, University of Zürich, Switzerland
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29
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Nadeem SQ, Feun LG, Bruce-Gregorios JH, Green B. Post radiation sarcoma (malignant fibrous histiocytoma) of the cervical spine following ependymoma (a case report). J Neurooncol 1991; 11:263-8. [PMID: 1668408 DOI: 10.1007/bf00165536] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
A case is reported of a 36 y/o man treated with radiation therapy for cervical cord ependymoma who developed malignant fibrous histiocytoma of the cervical spine 15 years later. Pathology revealed the sarcoma adjacent to the recurrent ependymoma. Post-radiation sarcomas following treatment of central nervous system malignancies is discussed.
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Affiliation(s)
- S Q Nadeem
- Department of Oncology, Silvester Comprehensive Cancer Center, University of Miami
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30
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Neglia JP, Meadows AT, Robison LL, Kim TH, Newton WA, Ruymann FB, Sather HN, Hammond GD. Second neoplasms after acute lymphoblastic leukemia in childhood. N Engl J Med 1991; 325:1330-6. [PMID: 1922234 DOI: 10.1056/nejm199111073251902] [Citation(s) in RCA: 418] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Effective forms of treatment for acute lymphoblastic leukemia (ALL) in childhood now result in survival rates above 70 percent at five years, but the treatments are potentially carcinogenic. To determine the magnitude of this risk and identify possible risk factors for the development of second neoplasms, we studied a large cohort of children treated for ALL. METHODS AND RESULTS. We undertook a retrospective cohort study of 9720 children who had been given a diagnosis of ALL between June 1972 and August 1988 and had been treated according to the therapeutic protocols of the Children's Cancer Study Group. The median follow-up was 4.7 years (range, 2 months to 16 years). We found that 43 second neoplasms occurred among the children in the cohort, including 24 neoplasms of the central nervous system, 10 new leukemias and lymphomas, and 9 other neoplasms. This represented a 7-fold excess of all cancers and a 22-fold excess of neoplasms of the central nervous system. The estimated cumulative proportion of children in whom a second neoplasm developed was 2.53 percent 15 years after diagnosis (95 percent confidence limits, 1.74 percent and 3.38 percent). An even higher risk, particularly of central nervous system tumors, was evident in children five years of age or less at the time of the diagnosis of ALL (P = 0.012). All central nervous system neoplasms developed in children who had previously undergone irradiation. There was no association with exposure to cyclophosphamide or anthracyclines. CONCLUSIONS There is a substantial excess of second neoplasms, especially of the central nervous system, among children treated for ALL. Children five years old or younger and those receiving radiation are at higher risk, especially for second tumors arising in the central nervous system.
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Affiliation(s)
- J P Neglia
- Children's Cancer Study Group, Arcadia, CA 91066-6012
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31
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Cohen ME, Duffner PK. Long-term consequences of CNS treatment for childhood cancer, Part I: Pathologic consequences and potential for oncogenesis. Pediatr Neurol 1991; 7:157-63. [PMID: 1878094 DOI: 10.1016/0887-8994(91)90078-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The pathologic changes associated with the treatment of cancer of the nervous system are reviewed. Computed tomographic, magnetic resonance imaging, and positron emission tomographic findings of these abnormalities are described, followed by discussion of the known histopathologic features. For the most part, pathologic effects are primary vascular and/or demyelinating. We review each of these effects at all levels of the neural axis. This review concludes with a discussion of the risk of developing second malignancies. Although this complication is infrequent, the likelihood that survivors of childhood cancer will develop a second malignancy is 10 times that of age-matched controls. This phenomenon in part relates to genetic predisposition, environmental factors, and host susceptibility. These qualifications not withstanding, most studies implicate central nervous system radiation with and without chemotherapy as the primary etiology for second malignancies.
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Affiliation(s)
- M E Cohen
- Department of Neurology, State University of New York, Buffalo
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32
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Vowels MR, Tobias V, Mameghan H. Second intracranial neoplasms following treatment of childhood acute lymphoblastic leukaemia. J Paediatr Child Health 1991; 27:43-6. [PMID: 2043390 DOI: 10.1111/j.1440-1754.1991.tb00344.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
We report a boy with acute lymphoblastic leukaemia (ALL) treated with chemotherapy and prophylactic cranial irradiation to a dose of 24 Gy. Six years after diagnosis he developed a glioma and died. Prior to 1979, four cases of second malignant neoplasm (SMN) of the brain had been reported in children treated for ALL. These SMNs occurred within 2 years of the original diagnosis (median 1.3 years) and at least two of four patients had not received prior radiotherapy. Since 1979, 28 cases of SMN of the brain have been reported including nine of 468 (1.9%) long-term survivors in one study. All occurred more than 3.7 years from diagnosis (median 6.5 years; range 4-13 years) and all received cranial irradiation (median 24 Gy; range 20-48 Gy). These data indicate a change in the pattern of SMNs which is most likely due to the introduction of cranial irradiation. As well, the frequency of SMNs in children treated for ALL appears to have increased, although it is still no greater than the risk of SMNs developing following the treatment of any other primary childhood neoplasm.
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Affiliation(s)
- M R Vowels
- Department of Haematology and Oncology, Prince of Wales Children's Hospital, Randwick, New South Wales, Australia
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33
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Abstract
Radiation-induced gliomas are uncommon, with only 73 cases on record to date. The disease that most frequently occasioned radiation therapy has been acute lymphoblastic leukemia (ALL). Three more cases are added here, two after irradiation for ALL and one after irradiation for tinea capitis. In a review of the relevant literature, the authors stress the possibility that the ALL-glioma and the retinoblastoma-glioma links point to syndromes in their own right that may occur without radiation therapy.
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Affiliation(s)
- M Salvati
- Department of Neurological Sciences-Neurosurgery, University of Rome La Sapienza, Italy
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34
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35
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Cavin LW, Dalrymple GV, McGuire EL, Maners AW, Broadwater JR. CNS tumor induction by radiotherapy: a report of four new cases and estimate of dose required. Int J Radiat Oncol Biol Phys 1990; 18:399-406. [PMID: 2137438 DOI: 10.1016/0360-3016(90)90107-u] [Citation(s) in RCA: 30] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
We have analyzed 60 cases of intra-axial brain tumors associated with antecedent radiation therapy. These include four new cases. The patients had originally received radiation therapy for three reasons: (a) cranial irradiation for acute lymphoblastic leukemia (ALL), (b) definitive treatment of CNS neoplasia, and (c) treatment of benign disease (mostly cutaneous infections). The number of cases reported during the past decade has greatly increased as compared to previous years. Forty-six of the 60 intra-axial tumors have been reported since 1978. The relative risk of induction of an intra-axial brain tumor by radiation therapy is estimated to be more than 100, as compared to individuals who have not had head irradiation.
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Affiliation(s)
- L W Cavin
- Nuclear Medicine Service, John L. McClellan Veterans Administration Hospital, Little Rock, AR 72205
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36
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Pompili A. Radiation-induced gliomas. J Neurosurg 1990; 72:311-2. [PMID: 2295929 DOI: 10.3171/jns.1990.72.2.0311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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37
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Abstract
Increasing numbers of childhood ALL survivors have increased the need to assess the physical and psychosocial functioning of this group in a careful manner. This article reviews data on the frequency and types of second malignancies, structural and functional changes in the central nervous system, endocrine effects on growth and reproduction, and psychosocial aspects of development. Most long-term survivors of ALL do not have serious or life-threatening medical problems; however, medical and psychosocial problems may not be insignificant and may require coordinated management over prolonged periods.
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Affiliation(s)
- J Ochs
- Department of Pediatrics, University of Tennessee, Memphis College of Medicine
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38
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Fontana M, Stanton C, Pompili A, Amadori S, Mandelli F, Meloni G, Riccio A, Rubinstein LJ. Late multifocal gliomas in adolescents previously treated for acute lymphoblastic leukemia. Cancer 1987; 60:1510-8. [PMID: 3476182 DOI: 10.1002/1097-0142(19871001)60:7<1510::aid-cncr2820600718>3.0.co;2-v] [Citation(s) in RCA: 50] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Three of 37 adolescents in long-term remission from childhood acute lymphoblastic leukemia (ALL) developed malignant multifocal gliomas several years after completing treatment that included central nervous system (CNS) prophylaxis with radiation (RT) and intrathecal methotrexate (IT-MTX). No recurrence of the leukemia was evident when the CNS tumors were discovered. Seventeen other similar cases have been recorded. The occurrence of second malignancies is reviewed in the context of this development and of the oncogenic effects of radiation. It is probable that prolonged exposure to IT-MTX may have had a synergistic effect with radiation in contributing to the unusual incidence of glial tumors in these patients.
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39
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Dropcho EJ, Wisoff JH, Walker RW, Allen JC. Supratentorial malignant gliomas in childhood: a review of fifty cases. Ann Neurol 1987; 22:355-64. [PMID: 2823687 DOI: 10.1002/ana.410220312] [Citation(s) in RCA: 68] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
From 1977 to 1986, 50 children aged 15 months to 18 years were treated for supratentorial malignant gliomas at the Memorial Sloan-Kettering Cancer Center and the New York University Medical Center. Thirteen patients had glioblastoma multiforme, 29 had anaplastic astrocytomas, and 8 had malignant gliomas. In 10 patients the tumor evolved from a low-grade lesion. Seven patients, including 2 patients with neurofibromatosis, developed multiple primary malignant neoplasms. The median time to tumor progression after surgery was 31 weeks, with local recurrence representing the mode of treatment failure in nearly all patients. Notable clinical features included symptomatic leptomeningeal metastasis (13 patients) and intratumoral hemorrhage (9 patients). The estimated median survival time for all 50 patients was 98 weeks, with a 3-year survival rate of 32%. A trend toward longer survival was seen in patients 12 years of age or younger at diagnosis. There was no apparent correlation between survival and tumor histology or tumor location. Recommendations for management are presented.
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Affiliation(s)
- E J Dropcho
- Department of Neurology, Memorial Sloan-Kettering Cancer Center, New York, NY
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40
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Rimm IJ, Li FC, Tarbell NJ, Winston KR, Sallan SE. Brain tumors after cranial irradiation for childhood acute lymphoblastic leukemia. A 13-year experience from the Dana-Farber Cancer Institute and the Children's Hospital. Cancer 1987; 59:1506-8. [PMID: 3545441 DOI: 10.1002/1097-0142(19870415)59:8<1506::aid-cncr2820590819>3.0.co;2-p] [Citation(s) in RCA: 100] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Brain tumors developed in two children after they had received cranial irradiation as central nervous system therapy for acute lymphoblastic leukemia. A review of the literature demonstrated an increased incidence of brain tumors in survivors of acute lymphoblastic leukemia who received central nervous system irradiation. Most of the brain tumors occurred within a decade after radiotherapy. Further data will be required to determine whether early post-radiation brain tumors in patients with acute lymphoblastic leukemia are due to the central nervous system irradiation or to a genetic predisposition.
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41
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Rubinstein LJ. The correlation of neoplastic vulnerability with central neuroepithelial cytogeny and glioma differentiation. J Neurooncol 1987; 5:11-27. [PMID: 3037035 DOI: 10.1007/bf00162761] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
The vulnerability of neuroepithelial cells in the central nervous system (CNS) to neoplastic transformation results from the interaction of several factors: the existence of a reserve population of stem cells, the capability of differentiated cells to reenter the kinetic cycle, the number of replicating cells at risk at a particular time, the length of time during which a particular cell population remains in the cycle, the state of differentiation and the further differentiation potential of that population, and the steps of differentiation that are achieved in successive cell generations. This concept explains many aspects of CNS tumor incidence and the relationship of central neuroepithelial embryonal tumors to tumors of adult cell type. The incidence of different types of central neuroepithelial tumors can be correlated with the width of the window of neoplastic vulnerability. Examples illustrating the existence of only a narrow window include such rare tumors as medulloepitheliomas, cerebral neuroblastomas, gangliogliomas and ependymoblastomas. By contrast, cerebellar medulloblastomas, astrocytomas, mixed astrocytomas and oligodendrogliomas, and glioblastomas exemplify instances in which a relatively wider window of vulnerability exists in the light of cellular neuro-ontogeny and of the capacity of glial cells for postnatal replication. The relationship that may occasionally be established between the development of a glioma and the production of cellular gliosis such as may follow brain injury or accompany multiple sclerosis can also be viewed in the light of that concept. Increasing awareness is needed concerning the development of postradiation gliomas, in particular after the apparently successful treatment of acute lymphocytic leukemia.
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