Skip to main content

Advertisement

SpringerLink
Log in

Risk and survival outcomes of radiation-induced CNS tumors

  • Topic Review
  • Published:
Journal of Neuro-Oncology Aims and scope Submit manuscript

Abstract

Patients treated with cranial radiation are at risk of developing secondary CNS tumors. Understanding the incidence, treatment, and long-term outcomes of radiation-induced CNS tumors plays a role in clinical decision-making and patient education. Additionally, as meningiomas and pituitary tumors have been detected at increasing rates across all ages and may potentially be treated with radiation, it is important to know and communicate the risk of secondary tumors in children and adults. After conducting an extensive literature search, we identified publications that report incidence and long-term outcomes of radiation-induced CNS tumors. We reviewed 14 studies in children, which reported that radiation confers a 7- to 10-fold increase in subsequent CNS tumors, with a 20-year cumulative incidence ranging from 1.03 to 28.9 %. The latency period for secondary tumors ranged from 5.5 to 30 years, with gliomas developing in 5–10 years and meningiomas developing around 15 years after radiation. We also reviewed seven studies in adults, where the two strongest studies showed no increased risk while the remaining studies found a higher risk compared to the general population. The latency period for secondary CNS tumors in adults ranged from 5 to 34 years. Treatment and long-term outcomes of radiation-induced CNS tumors have been documented in four case series, which did not conclusively demonstrate that secondary CNS tumors fared worse than primary CNS tumors. Radiation-induced CNS tumors remain a rare occurrence that should not by itself impede radiation treatment. Additional investigation is needed on the risk of radiation-induced tumors in adults and the long-term outcomes of these tumors.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Ostrom QT, Gittleman H, Liao P, Rouse C, Chen Y, Dowling J, Wolinsky Y, Kruchko C, Barnholtz-Sloan J (2012) CBTRUS statistical report: primary brain and central nervous system tumors diagnosed in the United States in 2005–2009. Neuro Oncol 14(suppl 5):1–57

    Article  Google Scholar 

  2. CBTRUS (2009) 2009-2010 CBTRUS statistical report: primary brain and central nervous system tumors diagnosed in eighteen states in 2002–2006

  3. CBTRUS (2012) CBTRUS statistical report: primary brain and central nervous system tumors diagnosed in the united states in 2004–2008 (March 23, 2012 Revision)

  4. Petersen O (1954) Radiation Cancer. Acta Radiol 42:221–236

    Article  CAS  PubMed  Google Scholar 

  5. Cahan WG, Woodard HQ, Higinbotham NL, Stewart FW, Coley BL (1998) Sarcoma arising in irradiated bone: report of eleven cases. 1948. Cancer 82:8–34

    Article  CAS  PubMed  Google Scholar 

  6. Bowers DC, Nathan PC, Constine L, Woodman C, Bhatia S, Keller K, Bashore L (2013) Subsequent neoplasms of the CNS among survivors of childhood cancer: a systematic review. Lancet Oncol 14:e321–e328

    Article  PubMed  PubMed Central  Google Scholar 

  7. Ron E, Modan B, Boice JD, Alfandary E, Stovall M, Chetrit A, Katz L (1988) Tumors of the brain and nervous system after radiotherapy in childhood. N Engl J Med 319:1033–1039

    Article  CAS  PubMed  Google Scholar 

  8. Walter AW, Hancock ML, Pui CH, Hudson MM, Ochs JS, Rivera GK, Pratt CB, Boyett JM, Kun LE (1998) Secondary brain tumors in children treated for acute lymphoblastic leukemia at St Jude Children’s Research Hospital. J Clin Oncol 16:3761–3767

    CAS  PubMed  Google Scholar 

  9. Löning L, Zimmermann M, Reiter A, Kaatsch P, Henze G, Riehm H, Schrappe M (2000) Secondary neoplasms subsequent to Berlin-Frankfurt-Münster therapy of acute lymphoblastic leukemia in childhood: significantly lower risk without cranial radiotherapy. Blood 95:2770–2775

    PubMed  Google Scholar 

  10. Bhatia S, Sather HN, Pabustan OB, Trigg ME, Gaynon PS, Robison LL (2002) Low incidence of second neoplasms among children diagnosed with acute lymphoblastic leukemia after 1983. Blood 99:4257–4264

    Article  CAS  PubMed  Google Scholar 

  11. Hijiya N, Hudson MM, Lensing S et al (2007) Cumulative incidence of secondary neoplasms as a first event after childhood acute lymphoblastic leukemia. JAMA 297:1207–1215

    Article  CAS  PubMed  Google Scholar 

  12. Armstrong GT, Liu Q, Yasui Y et al (2009) Long-term outcomes among adult survivors of childhood central nervous system malignancies in the childhood cancer survivor study. J Natl Cancer Inst 101:946–958

    Article  PubMed  PubMed Central  Google Scholar 

  13. Tsui K, Gajjar A, Li C et al (2014) Subsequent neoplasms in survivors of childhood central nervous system tumors: risk after modern multimodal therapy. Neuro Oncol 17:448–456

    PubMed  PubMed Central  Google Scholar 

  14. Tsang RW, Laperriere NJ, Simpson WJ, Brierley J, Panzarella T, Smyth HS (1993) Glioma arising after radiation therapy for pituitary adenoma. A report of four patients and estimation of risk. Cancer 72:2227–2233

    Article  CAS  PubMed  Google Scholar 

  15. Breen P, Flickinger JC, Kondziolka D, Martinez AJ (1998) Radiotherapy for nonfunctional pituitary adenoma: analysis of long-term tumor control. J Neurosurg 89:933–938

    Article  CAS  PubMed  Google Scholar 

  16. Minniti G, Traish D, Ashley S, Gonsalves A, Brada M (2005) Risk of second brain tumor after conservative surgery and radiotherapy for pituitary adenoma: update after an additional 10 years. J Clin Endocrinol Metab 90:800–804

    Article  CAS  PubMed  Google Scholar 

  17. Norberg L, Johansson R, Rasmuson T (2008) Pituitary adenomas in northern Sweden: a study on therapy choices and the risk of second primary tumours. Clin Endocrinol (Oxf) 68:780–785

    Article  Google Scholar 

  18. Norberg L, Johansson R, Rasmuson T (2010) Intracranial tumours after external fractionated radiotherapy for pituitary adenomas in northern Sweden. Acta Oncol 49:1276–1282

    Article  PubMed  Google Scholar 

  19. van Varsseveld NC, van Bunderen CC, Ubachs DHH, Franken AAM, Koppeschaar HPF, van der Lely AJ, Drent ML (2015) Cerebrovascular events, secondary intracranial tumors, and mortality after radiotherapy for nonfunctioning pituitary adenomas: a subanalysis from the Dutch National Registry of Growth Hormone Treatment in Adults. J Clin Endocrinol Metab 100:1104–1112

    Article  PubMed  Google Scholar 

  20. Gold DG, Neglia JP, Dusenbery KE (2003) Second neoplasms after megavoltage radiation for pediatric tumors. Cancer 97:2588–2596

    Article  PubMed  Google Scholar 

  21. Neglia JP, Robison LL, Stovall M et al (2006) New primary neoplasms of the central nervous system in survivors of childhood cancer: a report from the childhood cancer survivor study. J Natl Cancer Inst 98:1528–1537

    Article  PubMed  Google Scholar 

  22. Sharif S, Ferner R, Birch JM, Gillespie JE, Gattamaneni HR, Baser ME, Evans DGR (2006) Second primary tumors in neurofibromatosis 1 patients treated for optic glioma: substantial risks after radiotherapy. J Clin Oncol 24:2570–2575

    Article  PubMed  Google Scholar 

  23. Cardous-Ubbink MC, Heinen RC, Bakker PJM, van den Berg H, Oldenburger F, Caron HN, Voûte PA, van Leeuwen FE (2007) Risk of second malignancies in long-term survivors of childhood cancer. Eur J Cancer 43:351–362

    Article  CAS  PubMed  Google Scholar 

  24. Goshen Y, Stark B, Kornreich L, Michowiz S, Feinmesser M, Yaniv I (2007) High incidence of meningioma in cranial irradiated survivors of childhood acute lymphoblastic leukemia. Pediatr Blood Cancer 49:294–297

    Article  PubMed  Google Scholar 

  25. Taylor AJ, Little MP, Winter DL et al (2010) Population-based risks of CNS tumors in survivors of childhood cancer: the British childhood cancer survivor study. J Clin Oncol 28:5287–5293

    Article  PubMed  PubMed Central  Google Scholar 

  26. Vinchon M, Leblond P, Caron S, Delestret I, Baroncini M, Coche B (2011) Radiation-induced tumors in children irradiated for brain tumor: a longitudinal study. Childs Nerv Syst 27:445–453

    Article  PubMed  Google Scholar 

  27. You SH, Lyu CJ, Kim D-S, Suh C-O (2013) Second primary brain tumors following cranial irradiation for pediatric solid brain tumors. Childs Nerv Syst 29:1865–1870

    Article  PubMed  Google Scholar 

  28. De Gonzalez AB, Curtis RE, Kry SF, Gilbert E, Lamart S, Berg CD, Stovall M, Ron E (2011) Proportion of second cancers attributable to radiotherapy treatment in adults: a cohort study in the US SEER cancer registries. Lancet Oncol 12:353–360

    Article  PubMed Central  Google Scholar 

  29. Kutsenko A, Berrington de Gonzalez A, Curtis RE, Rajaraman P (2014) Risk of second benign brain tumors among cancer survivors in the surveillance, epidemiology, and end results program. Cancer Causes Control 25:659–668

    Article  PubMed  Google Scholar 

  30. Shapiro S, Mealey J, Sartorius C (1989) Radiation-induced intracranial malignant gliomas. J Neurosurg 71:77–82

    Article  CAS  PubMed  Google Scholar 

  31. Carret AS, Tabori U, Crooks B, Hukin J, Odame I, Johnston DL, Keene DL, Freeman C, Bouffet E (2006) Outcome of secondary high-grade glioma in children previously treated for a malignant condition: a study of the Canadian Pediatric Brain Tumour Consortium. Radiother Oncol 81:33–38

    Article  PubMed  Google Scholar 

  32. Kleinschmidt-Demasters BK, Kang JS, Lillehei KO (2006) The burden of radiation-induced central nervous system tumors: a single institution s experience. J Neuropathol Exp Neurol 65:204–216

    Article  CAS  PubMed  Google Scholar 

  33. Galloway TJ, Indelicato DJ, Amdur RJ, Swanson EL, Morris CG, Marcus RB (2011) Favorable outcomes of pediatric patients treated with radiotherapy to the central nervous system who develop radiation-induced meningiomas. Int J Radiat Oncol Biol Phys 79:117–120

    Article  PubMed  Google Scholar 

  34. Baker KS (2003) New malignancies after blood or marrow stem-cell transplantation in children and adults: incidence and risk factors. J Clin Oncol 21:1352–1358

    Article  PubMed  Google Scholar 

  35. Ng AK, Kenney LB, Gilbert ES, Travis LB (2010) Secondary malignancies across the age spectrum. Semin Radiat Oncol 20:67–78

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA

    Jessica W. Lee

  2. Stich Radiation Oncology, Weill Cornell Medical College/New York-Presbyterian Hospital, 525 E. 68th Street at York Avenue, New York, NY, 10065, USA

    A. Gabriella Wernicke

  3. Department of Neurosurgery, Weill Cornell Medical College/New York-Presbyterian Hospital, 525 East 68th Street, New York, NY, 10065, USA

    A. Gabriella Wernicke

Authors
  1. Jessica W. Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. A. Gabriella Wernicke
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to A. Gabriella Wernicke.

Ethics declarations

Conflict of interest

None.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Lee, J.W., Wernicke, A. Risk and survival outcomes of radiation-induced CNS tumors. J Neurooncol 129, 15–22 (2016). https://doi.org/10.1007/s11060-016-2148-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11060-016-2148-3

Keywords

Search

Navigation