Radiation-induced cavernous hemangiomas of the brain: a late effect predominantly in children.
BACKGROUND
The induction of cavernomas as a consequence of brain irradiation was first suspected in 1994 and has been controversial since that time.


METHODS
Between 1986 and 2000, 189 cerebral cavernomas were diagnosed in the Neurosurgical Department of the University of Heidelberg; of those patients, 5 had received prior radiation therapy. The ages of these 5 patients were compared with those of the 184 others with naturally occuring cavernomas. In an examination of 40 patients with cavernomas occurring after radiation (the 5 mentioned above, plus 35 from the literature) the age distribution was investigated, and a possible relationship between radiation dosage and latency interval to diagnosis of cavernoma was examined.


RESULTS
Almost one in four of the patients under 15 years of age diagnosed with a cerebral cavernoma in the Neurosurgical Department of the University of Heidelberg had received prior radiation. In 40 patients with cavernomas and prior radiation (5 from Heidelberg, 35 from the literature), there was a clear accumulation in the age group of 10-19 years (50%). Most of those patients had received radiation in the first 10 years of life. The accumulation of cavernomas after radiation in childhood could not be explained by a greater frequency of radiation exposure in children compared to adults. In children up to 10 years of age at the time of radiation therapy, a dose of 3000 cGy and higher was followed by a shorter latency interval to incidence of cavernoma (P = 0.0018). In patients older than 10 years at the time of radiation, postradiation cavernomas only occurred when dosage was 3000 cGy or greater.


CONCLUSIONS
These results indicate a correlation between radiation and cavernoma, particularly in children under 10 years of age at the time of radiation therapy. In adults, cavernomas after radiation rarely occur, and then only after higher radiation dosages (3000 cGy or more).
Heckl
Stefan
S
Department of Oncological Diagnostics and Therapy, German Cancer Research Center, Heidelberg, Germany. s.heckl@dkfz.de
Aschoff
Alfred
A
Kunze
Stefan
S
D000328:Adult; D000367:Age Factors; D000368:Aged; D001921:Brain / Q000528:radiation effects*; D001932:Brain Neoplasms / Q000209:etiology*; D002675:Child, Preschool; D020786:Hemangioma, Cavernous, Central Nervous System / Q000209:etiology*; D006801:Humans; D008875:Middle Aged; D011878:Radiotherapy / Q000009:adverse effects*