title: Cerebral necrosis after 25Gy radiotherapy in childhood followed 28 years later by 54Gy radiotherapy.
abstract: The development of brain necrosis is life-long risk of repeat radiation therapy, even after a long time interval and a moderate radiation dose. We report on a 34-year-old patient who had prophylactic cranial irradiation with 25Gy and adjuvant chemotherapy in childhood for leukaemia and in adulthood, 28 years later, therapeutic radiotherapy with 54Gy for an atypical (WHO grade II) meningioma. About 2 years later he developed a contrast-enhancing lesion on MRI-scan that was indicative of a tumor according to a thallium-201 ((201)Tl) SPECT scan. Histopathology of the operated contrast-enhancing lesion showed extensive radionecrosis. Radiation necrosis is a small but serious risk after repeat radiation therapy, even after a very long-term interval, the delivery of small fractions and an average cumulative total dose. Patients undergoing repeat radiotherapy therefore need to be followed life-long for potential late radiation toxicity.
authors.affiliation: Department of Neurosurgery, Academic Medical Center, University of Amsterdam, The Netherlands. r.w.koot@lumc.nl
authors.forename: Radboud W
authors.initials: RW
authors.lastname: Koot
authors.forename: Lukas J A
authors.initials: LJ
authors.lastname: Stalpers
authors.forename: Eleonora
authors.initials: E
authors.lastname: Aronica
authors.forename: D
authors.initials: D
authors.lastname: Andries Bosch
mesh_terms: D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D002675:Child, Preschool; D003131:Combined Modality Therapy; D016371:Cranial Irradiation / Q000009:adverse effects*; D003937:Diagnosis, Differential; D005500:Follow-Up Studies; D005911:Gliosis / Q000473:pathology; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008279:Magnetic Resonance Imaging; D008297:Male; D008577:Meningeal Neoplasms / Q000532:radiotherapy* / Q000601:surgery; D008579:Meningioma / Q000532:radiotherapy* / Q000601:surgery; D009336:Necrosis; D009378:Neoplasms, Multiple Primary / Q000532:radiotherapy* / Q000601:surgery; D009381:Neoplasms, Radiation-Induced / Q000532:radiotherapy* / Q000601:surgery; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000188:drug therapy / Q000532:radiotherapy*; D011832:Radiation Injuries / Q000175:diagnosis*; D018714:Radiotherapy, Adjuvant; D019233:Retreatment; D013702:Temporal Lobe / Q000473:pathology / Q000528:radiation effects*; D013794:Thallium Radioisotopes; D015899:Tomography, Emission-Computed, Single-Photon; D014057:Tomography, X-Ray Computed
chemical_list: D013794:Thallium Radioisotopes