title: Radiation-induced tumor after stereotactic radiosurgery and whole brain radiotherapy: case report and literature review.
abstract: Radiation-induced neoplasms are extremely rare after stereotactic radiosurgery. To date, only 3 cases meet Cahan's criteria in the world literature. We present a fourth case of a radiation-induced neoplasm arising after radiosurgery. The patient is a 43-year-old woman who presented with a right cerebellar anaplastic astrocytoma 64 months after radiosurgery for metastatic melanoma. Initially, 3 brain metastases involving the inferior right temporal (2 tumors) and right frontal regions were treated. Following radiosurgery, the patient underwent whole brain radiotherapy (37.5 Gy). Twenty-two months later, a second radiosurgical procedure was performed for a recurrent right temporal lobe metastasis. The area of cerebellum where the glioma developed received a maximum dose of 7.7 and 1.5 Gy during the 2 procedures, respectively. Support that radiosurgery contributed to the development of this glioma are the tumor's location and the rarity of adult cerebellar astrocytomas. The risk of radiation-induced tumors after radiosurgery is unknown. To better define the incidence of radiation-induced neoplasms after radiosurgery, all potential cases should be presented and discussed in an open, candid fashion.
authors.affiliation: Department of Neurological Surgery, Mayo Clinic and Foundation, Rochester, MN 55905, USA.
authors.forename: Jon I
authors.initials: JI
authors.lastname: McIver
authors.forename: Bruce E
authors.initials: BE
authors.lastname: Pollock
mesh_terms: D000328:Adult; D001254:Astrocytoma / Q000209:etiology* / Q000473:pathology; D001932:Brain Neoplasms / Q000532:radiotherapy / Q000556:secondary; D002528:Cerebellar Neoplasms / Q000209:etiology* / Q000473:pathology; D003131:Combined Modality Therapy; D016371:Cranial Irradiation / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008545:Melanoma / Q000532:radiotherapy / Q000556:secondary; D009364:Neoplasm Recurrence, Local / Q000532:radiotherapy; D009381:Neoplasms, Radiation-Induced / Q000209:etiology* / Q000473:pathology; D011829:Radiation Dosage; D016634:Radiosurgery / Q000009:adverse effects*; D016896:Treatment Outcome