Radiation-induced meningioma following prophylactic radiotherapy for acute lymphoblastic leukemia in childhood

Secondary meningioma after cranial irradiation: case series and comprehensive literature review

BACKGROUND

Secondary meningioma after cranial irradiation, so-called radiation-induced meningioma, is one of the important late effects after cranial radiation therapy. In this report, we analyzed our case series of secondary meningioma after cranial irradiation and conducted a critical review of literature to reveal the characteristics of secondary meningioma.

MATERIALS AND METHODS

We performed a comprehensive literature review by using Pubmed, MEDLINE and Google scholar databases and investigated pathologically confirmed individual cases. In our institute, we found pathologically diagnosed seven cases with secondary meningioma between 2000 and 2018. Totally, 364 cases were analyzed based on gender, WHO grade, radiation dose, chemotherapy. The latency years from irradiation to development of secondary meningioma were analyzed with Kaplan-Meier analysis. Spearman's correlation test was used to determine the relationship between age at irradiation and the latency years.

RESULTS

The mean age at secondary meningioma development was 35.6 ± 15.7 years and the mean latency periods were 22.6 ± 12.1 years. The latency periods from irradiation to the development of secondary meningioma are significantly shorter in higher WHO grade group (P = 0.0026, generalized Wilcoxon test), higher radiation dose group (P < 0.0001) and concomitant systemic chemotherapy group (P = 0.0003). Age at irradiation was negatively associated with the latency periods (r = -0.23231, P < 0.0001, Spearman's correlation test).

CONCLUSION

Cranial irradiation at older ages, at higher doses and concomitant chemotherapy was associated with a shorter latency period to develop secondary meningiomas. However, even low-dose irradiation can cause secondary meningiomas after a long latency period. Long-term follow-up is necessary to minimize the morbidity and mortality caused by secondary meningioma after cranial irradiation.

Radiation-induced meningiomas (RIM) in adults: A single-centre retrospective experience

Introduction

Radiotherapy of central nervous system (CNS) is treatment against many paediatric cancers, even if it is a well-recognized risk factor for meningioma formation. An increased risk of developing secondary brain tumors like radiation-induced meningiomas (RIM) is related to irradiated patients.

Research question

This retrospective study aims to present RIM cases treated in a single tertiary-hospital in Greece and compare the results with international literature and cases of sporadic meningiomas.

Materials and methods

A single-centre retrospective study of all patients diagnosed between January 2012 and September 2022 with RIM after having been irradiated in CNS for paediatric cancer was undertaken through hospital's electronic record and clinical notes, identifying baseline demographics and latency period.

Results

Thirteen patients were identified with RIM diagnosis after receiving irradiation for Acute Lymphoblastic Leukaemia (69.2%), Premature Neuro-Ectodermal Tumour (23.1%), and Astrocytoma (7.7%). Median age at irradiation was 5 years old and 32 years old at RIM's presentation. The latent period from irradiation to meningioma diagnosis was 26.23 ​± ​5.96 years. After surgical excision, histopathologic results showed grade I meningiomas in 12 out of thirteen cases, while only one atypical meningioma was diagnosed.

Conclusion

Patients who underwent CNS-radiotherapy in childhood for any condition have an increased risk of developing secondary brain tumors such as radiation-induced meningiomas. RIMs resemble sporadic meningiomas in symptomatology, location, treatment, and histologic grade. However, long-term follow-up and regular check-ups are recommended in irradiated patients due to short latency period from irradiation to RIM development, which means younger age patients than those with sporadic meningiomas cases.

Radiation-Induced Meningiomas: An Exhaustive Review of the Literature

OBJECTIVE

Radiation-induced meningioma (RIM) is an uncommon late risk of cranial irradiation. We conducted an exhaustive review of individual patient data to characterize RIM.

METHODS

Using a systematic search of the PubMed database, we performed a comprehensive literature review to characterize and investigate RIM. Student t tests were used to evaluate differences between variables. A Kaplan-Meier analysis was used to assess survival. Statistical significance was assessed using a log-rank test.

RESULTS

Our analysis included 251 cases of RIM. The average age at onset for the primary lesion was 13.0 ± 13.5 years, and the average radiation dose delivered to this lesion was 38.8 ± 16.8 Gy. Secondary meningiomas could be divided into grades I (140), II (55), and III (10) tumors. Thirty patients (11.9%) had multiple lesions, and 46 (18.3%) had recurrent meningiomas. The latency period between radiotherapy for primary lesions and the onset of meningiomas was 22.9 ± 11.4 years. The latency period was shorter for patients with grade III meningioma and for those in the high-dose and intermediate-dose radiation groups who received systemic chemotherapy. Aggressive meningiomas and multiple meningiomas were more common in the high-dose and intermediate-dose groups than in the low-dose group. The 5-year and 10-year survival rates for all patients with meningioma were 77.7% and 66.1%, respectively.

CONCLUSIONS

For patients treated with cranial radiotherapy, the risk of secondary meningioma warrants a longer follow-up period beyond the standard time frame typically designated for determining the risk of primary tumor relapse.

Meningioma after radiotherapy for malignancy

Complications of radiation exposure have gained importance with increasing cancer survivorship. Secondary malignancies have been associated with cranial radiation exposure. We present our experience with intracranial radiation-induced meningioma (RIM) and discuss the implications of its presentation and natural history for patient management. Patients diagnosed with meningioma who had received radiation therapy between 1960 and 2014 were identified. Records were retrospectively reviewed for details of radiation exposure, previous malignancies, meningioma subtypes, multiplicity and pathologic descriptions, treatment and follow-up. Thirty patients were diagnosed with RIM. Initial malignancies included acute lymphocytic leukemia (33.3%), medulloblastoma (26.7%) and glioma (16.7%) at a mean age of 8.1years (range 0.04-33years). The mean radiation dose was 34Gy (range 16-60Gy) and latency time to meningioma was 26years (range 8-51years). Twenty-one patients (70%) underwent surgery. Of these, 57.1% of tumors were World Health Organization (WHO) grade I while 42.9% were WHO II (atypical). The mean MIB-1 labeling index for patients with WHO I tumors was 5.44%, with 33.3% exhibiting at least 5% staining. Mean follow-up after meningioma diagnosis was 5.8years. Mortality was zero during the follow-up period. Meningioma is an important long-term complication of therapeutic radiation. While more aggressive pathology occurs more frequently in RIM than in sporadic meningioma, it remains unclear whether this translates into an effect on survival. Further study should be aimed at delineating the risks and benefits of routine surveillance for the development of secondary neoplasms after radiation therapy.

Radiation-induced meningiomas after high-dose cranial irradiation

Radiation-induced meningiomas (RIM) are known to occur after high and low dose cranial radiation therapy. Currently, RIM are the most common form of radiation-induced neoplasm reported. We present the largest series of RIM induced by high dose radiation reported thus far and review the literature. Radiation therapy was most commonly given for childhood malignancy. We compared our group of 26 patients with RIM with previously published reports of RIM, and also with 364 patients with spontaneous meningioma (SM) treated at The Royal Melbourne Hospital between 2007 and 2011 with regard to age, gender, and histopathology. In our group of patients with RIM, the mean age at presentation was 38.5 years, in comparison to 60.1 years for patients with SM. The female-to-male ratio was 1.88:1 in RIM compared to 2.37:1 for SM. Of the RIM, 86.5% were World Health Organization (WHO) grade I and 11.5% were grade II (atypical) meningiomas. There were no anaplastic or malignant RIM. Of the SM, 91.5% were WHO grade I, 7.1% WHO grade II, and 1.4% WHO grade III meningiomas. The characteristics of RIM induced by low dose radiation therapy have been well described. It is timely to consider RIM due to high dose radiation, which is now frequently employed in the management of various childhood and other malignancies.

Occurrence of symptomatic meningioma as a second neoplasm in patients with differentiated thyroid cancer treated with radioiodine

Occurrence of second tumors has been seen in patients with papillary and follicular thyroid cancer. We studied the occurrence of meningioma as a second neoplasm in patients with differentiated thyroid cancer treated with radioiodine at our institution.