Journal of Neuro-Oncology

, Volume 88, Issue 3, pp 315–320 | Cite as

Two metachronous tumors induced by radiation therapy: case report and review of the literature

  • Takashi Sasayama
  • Masamitsu Nishihara
  • Kazuhiro Tanaka
  • Katsu Mizukawa
  • Kazumasa Ehara
  • Naoki Kanomata
  • Eiji Kohmura
Clinical-patient studies


Various radiation-induced tumors, including meningioma, glioma, and sarcoma, have been reported; however, metachronous intracranial double tumors induced by radiation therapy are extremely rare. A 1-year-old boy had undergone tumor removal and craniospinal radiation therapy (30 Gy) for cerebellar medulloblastoma. At 24 years old, parasagittal meningioma developed in the left parietal region and was totally removed. Six years later, an infiltrative tumor was newly found in the right fronto-temporal white matter. The patient underwent stereotactic biopsy, and the tumor was found to be an anaplastic astrocytoma. Chromosomal analysis by fluorescence in situ hybridization (FISH) revealed loss of heterozygosity (LOH) of 1p. As the patient had previously had craniospinal irradiation, no additional radiation therapy was delivered. He underwent chemotherapy with temozolomide and the disease is now stable. Since both secondary tumors were located within the area of previous radiation and the patient did not have any genetic disease predisposing him to tumors, radiation therapy was considered to be responsible for their tumorigenesis. To our knowledge, this case is the fourth case of radiation-induced double CNS tumors arising after radiotherapy to be described in the literature. Whenever radiation is administered to children or young adults, careful serial screening studies are needed.


Radiation-induced tumor Medulloblastoma Meningioma Anaplastic astrocytoma 


  1. 1.
    Choudhary A, Pradhan S, Huda MF et al (2006) Radiation-induced meningioma with a short latent period following high dose cranial irradiation—case report and literature review. J Neurooncol 77:73–77PubMedCrossRefGoogle Scholar
  2. 2.
    Hope AJ, Mansur DB, Tu PH et al (2006) Metachronous secondary atypical meningioma and anaplastic astrocytoma after postoperative craniospinal irradiation for medulloblastoma. Childs Nerv Syst 22:1201–1207PubMedCrossRefGoogle Scholar
  3. 3.
    Al-Mefty O, Topsakal C, Pravdenkova S et al (2004) Radiation-induced meningiomas: clinical, pathological, cytokinetic, and cytogenetic characteristics. J Neurosurg 100:1002–1013PubMedGoogle Scholar
  4. 4.
    Amirjamshidi A, Abbassioun K (2004) Radiation-induced tumors of the central nervous system occurring in childhood and adolescence. Four unusual lesions in three patients and a review of the literature. Childs Nerv Syst 16:390–397CrossRefGoogle Scholar
  5. 5.
    Salvati M, Frati A, Russo N et al (2003) Radiation-induced gliomas: report of 10 cases and review of the literature. Surg Neurol 60:60–67PubMedCrossRefGoogle Scholar
  6. 6.
    Strojan P, Popović M, Jereb B (2000) Secondary intracranial meningiomas after high-dose cranial irradiation: report of five cases and review of the literature. Int J Radiat Oncol Biol Phys 48:65–73PubMedCrossRefGoogle Scholar
  7. 7.
    Alexander MJ, DeSalles AA, Tomiyasu U (1998) Multiple radiation-induced intracranial lesions after treatment for pituitary adenoma. Case report. J Neurosurg 88:111–115PubMedGoogle Scholar
  8. 8.
    Nishio S, Morioka T, Inamura T et al (1998) Radiation-induced brain tumours: potential late complications of radiation therapy for brain tumours. Acta Neurochir (Wien) 140:763–770CrossRefGoogle Scholar
  9. 9.
    Ron E, Modan B, Boice JD Jr et al (1998) Tumors of the brain and nervous system after radiotherapy in childhood. N Engl J Med 319:1033–1039CrossRefGoogle Scholar
  10. 10.
    Tada M, Sawamura Y, Abe H et al (1997) Homozygous p53 gene mutation in a radiation-induced glioblastoma 10 years after treatment for an intracranial germ cell tumor: case report. Neurosurgery 40:393–396PubMedCrossRefGoogle Scholar
  11. 11.
    Goldstein AM, Yuen J, Tucker MA (1997) Second cancers after medulloblastoma: population-based results from the United States and Sweden. Cancer Causes Control 8:865–871PubMedCrossRefGoogle Scholar
  12. 12.
    Kaschten B, Flandroy P, Reznik M et al (1995) Radiation-induced gliosarcoma. Case report and review of the literature. J Neurosurg 83:154–162PubMedGoogle Scholar
  13. 13.
    Chang SM, Barker FG II, Larson DA et al (1995) Sarcomas subsequent to cranial irradiation. Neurosurgery 36:685–690PubMedCrossRefGoogle Scholar
  14. 14.
    Ghim TT, Seo JJ, O’Brien M et al (1993) Childhood intracranial meningiomas after high-dose irradiation. Cancer 71:4091–4095PubMedCrossRefGoogle Scholar
  15. 15.
    Brada M, Ford D, Ashley S et al (1992) Risk of second brain tumour after conservative surgery and radiotherapy for pituitary adenoma. BMJ 304:1343–1346PubMedGoogle Scholar
  16. 16.
    Harrison MJ, Wolfe DE, Lau TS et al (1991) Radiation-induced meningiomas: experience at the Mount Sinai Hospital and review of the literature. J Neurosurg 75:564–574PubMedGoogle Scholar
  17. 17.
    Shapiro S, Mealey J Jr, Sartorius C (1989) Radiation-induced intracranial malignant liomas. J Neurosurg 71:77–82PubMedGoogle Scholar
  18. 18.
    Liwnicz BH, Berger TS, Liwnicz RG et al (1985) Radiation-associated gliomas: a report of four cases and analysis of postradiation tumors of the central nervous system. Neurosurgery 17:436–445PubMedCrossRefGoogle Scholar
  19. 19.
    Sachs RK, Hlatky LR, Trask BJ (2000) Radiation-produced chromosome aberrations. Trends Genet 16:143–146PubMedCrossRefGoogle Scholar
  20. 20.
    Li M, Jendrossek V, Belka C (2007) The role of PDGF in radiation oncology. Radiat Oncol 11:2–5Google Scholar
  21. 21.
    Rothbart D, Awad IA, Lee J et al (1996) Expression of angiogenic factors and structural proteins in central nervous system vascular malformations. Neurosurgery 38:915–924PubMedCrossRefGoogle Scholar
  22. 22.
    Jeuken JW, von Deimling A, Wesseling P (2004) Molecular pathogenesis of oligodendroglial tumors. J Neurooncol 70:161–181PubMedCrossRefGoogle Scholar
  23. 23.
    Griffin CA, Burger P, Morsberger L et al (2006) Identification of der(1;19)(q10;p10) in five oligodendrogliomas suggests mechanism of concurrent 1p and 19q loss. J Neuropathol Exp Neurol 65:988–994PubMedCrossRefGoogle Scholar
  24. 24.
    Okumoto M, Park YG, Song CW et al (1999) Frequent loss of heterozygosity on chromosomes 4, 12 and 19 in radiation-induced lymphomas in mice. Cancer Lett 135:223–228PubMedCrossRefGoogle Scholar
  25. 25.
    Shoshan Y, Chernova O, Juen SS et al (2000) Radiation-induced meningioma: a distinct molecular genetic pattern? J Neuropathol Exp Neurol 59:614–620PubMedGoogle Scholar
  26. 26.
    Hata N, Shono T, Mizoguchi M et al (2007) Loss of heterozygosity analysis in an anaplastic oligodendroglioma arising after radiation therapy. Neurol Res 29:723–726PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC. 2008

Authors and Affiliations

  • Takashi Sasayama
    • 1
  • Masamitsu Nishihara
    • 1
  • Kazuhiro Tanaka
    • 1
  • Katsu Mizukawa
    • 1
  • Kazumasa Ehara
    • 1
  • Naoki Kanomata
    • 2
  • Eiji Kohmura
    • 1
  1. 1.Department of NeurosurgeryKobe University Graduate School of MedicineKobeJapan
  2. 2.Department of PathologyKobe University Graduate School of MedicineKobeJapan

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