Intracerebral cavernous hemangioma after cranial irradiation in childhood. Incidence and risk factors.
OBJECTIVE
Radiotherapy is an integral part of various therapeutic regimens in pediatric and adult oncology. Endocrine dysfunction, neurologic and psychiatric deficits, secondary malignancies and radiation-induced necrosis are well-known possible late effects of cranial irradiation. However, only sporadic cases of radiation-induced cavernous hemangiomas (RICH) have been reported so far.


METHODS
Pediatric patients who underwent cranial radiation therapy for malignant diseases between January 1980 and December 2003 were retrospectively analyzed. After the end of therapy they entered a detailed follow-up program.


RESULTS
Of 171 patients, eight (three patients with medulloblastoma, three patients with acute lymphoblastic leukemia, and one patient each with ependymoma and craniopharyngioma) developed intracerebral cavernoma 2.9-18.4 years after irradiation representing a cumulative incidence (according to the Kaplan-Meier method) of 2.24%, 3.86%, 4.95%, and 6.74% within 5, 10, 15, and 20 years following radiation therapy, respectively. In patients treated in the first 10 years of life, RICH occurred with shorter latency and significantly more often (p = 0.044) resulting in an even higher cumulative incidence.


CONCLUSIONS
These findings and previously published cases show that cavernous hemangiomas may occur after irradiation of the brain several years after the end of therapy irrespective of the radiation dose and type of malignancy. Particularly children < 10 years of age at the time of irradiation are at higher risk. Since patients with RICH frequently do not show symptoms but hemorrhage is a possible severe complication, imaging of the central nervous system should be performed routinely for longer follow- ups, particularly in patients who were treated as young children.
Strenger
Volker
V
Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Austria. volker.strenger@meduni-graz.at
Sovinz
Petra
P
Lackner
Herwig
H
Dornbusch
Hans Jürgen
HJ
Lingitz
Helga
H
Eder
Hans G
HG
Moser
Andrea
A
Urban
Christian
C
D000293:Adolescent; D000328:Adult; D001932:Brain Neoplasms / Q000175:diagnosis / Q000209:etiology* / Q000532:radiotherapy; D002528:Cerebellar Neoplasms / Q000532:radiotherapy; D002648:Child; D002675:Child, Preschool; D016371:Cranial Irradiation / Q000009:adverse effects*; D003397:Craniopharyngioma / Q000532:radiotherapy; D004806:Ependymoma / Q000532:radiotherapy; D005260:Female; D005500:Follow-Up Studies; D005625:Frontal Lobe / Q000473:pathology / Q000528:radiation effects; D020786:Hemangioma, Cavernous, Central Nervous System / Q000175:diagnosis / Q000209:etiology*; D006801:Humans; D007223:Infant; D008279:Magnetic Resonance Imaging; D008297:Male; D008527:Medulloblastoma / Q000532:radiotherapy; D009381:Neoplasms, Radiation-Induced / Q000175:diagnosis / Q000209:etiology*; D010296:Parietal Lobe / Q000473:pathology / Q000528:radiation effects; D010911:Pituitary Neoplasms / Q000532:radiotherapy; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000532:radiotherapy; D011879:Radiotherapy Dosage; D012307:Risk Factors; D013702:Temporal Lobe / Q000473:pathology / Q000528:radiation effects; D014057:Tomography, X-Ray Computed