title: The postirradiation incidence of cavernous angioma is higher in patients with childhood pineoblastoma or primitive neuroectodermal tumors than medulloblastoma.
abstract: OBJECTIVE
  The purpose of this study is to investigate the incidence of cavernous angioma (CVA) in long-term survivors of childhood embryonal tumors treated by cranial irradiation.
  
  
  METHODS
  Between 1990 and 2012, we treated 25 patients (13 males, 12 females) with embryonal tumors (17 medulloblastomas, 5 primitive neuroectodermal tumors (PNET), 3 pineoblastomas) with craniospinal irradiation. Follow-up ranged from 15.5 to 289.9 months, the irradiation dose to the whole neural axis from 18 to 36 Gy, and the total local dose from 49.6 to 60 Gy. All patients underwent follow-up magnetic resonance imaging (MRI) studies at least once a year, and the diagnosis of posttreatment CVA was based solely on MRI findings.
  
  
  RESULTS
  At the time of this writing, 18 were alive and free of the recurrence of the original disease or the development of secondary neoplasms other than CVA; another 2 were alive with medulloblastoma or diffuse astrocytoma. Posttreatment, 14 patients developed CVAs in the course of a median of 56.7 months; 13 of these presented with multiple CVAs. Patients who underwent radiation therapy (RT) at an age younger than 6 years developed multiple CVAs significantly earlier than those treated at a later age (p = 0.0110). Patients with PNET or pineoblastoma developed Zabramski type 1 and 2 CVA significantly earlier than did medulloblastoma patients (p = 0.0042).
  
  
  CONCLUSIONS
  We attribute the high rate of post-RT CVA in our long-term follow-up study of pediatric patients to the delivery of cranial irradiation for embryonal tumors, especially PNET and pineoblastoma, and recommend the regular, long-term follow-up of patients whose embryonal tumors were treated by cranial irradiation.
authors.affiliation: Department of Neurosurgery, Institute of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan, fyama@hiroshima-u.ac.jp.
authors.forename: Fumiyuki
authors.initials: F
authors.lastname: Yamasaki
authors.forename: Takeshi
authors.initials: T
authors.lastname: Takayasu
authors.forename: Ryo
authors.initials: R
authors.lastname: Nosaka
authors.forename: Masahiro
authors.initials: M
authors.lastname: Kenjo
authors.forename: Yuji
authors.initials: Y
authors.lastname: Akiyama
authors.forename: Atsushi
authors.initials: A
authors.lastname: Tominaga
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Sugiyama
authors.forename: Masao
authors.initials: M
authors.lastname: Kobayashi
authors.forename: Kaoru
authors.initials: K
authors.lastname: Kurisu
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D016371:Cranial Irradiation / Q000009:adverse effects*; D004307:Dose-Response Relationship, Radiation; D005260:Female; D006392:Hemangioma, Cavernous / Q000175:diagnosis / Q000401:mortality / Q000532:radiotherapy*; D006801:Humans; D015994:Incidence; D008137:Longitudinal Studies; D008279:Magnetic Resonance Imaging; D008297:Male; D008527:Medulloblastoma / Q000209:etiology* / Q000401:mortality; D009364:Neoplasm Recurrence, Local / Q000209:etiology* / Q000401:mortality; D009381:Neoplasms, Radiation-Induced / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology*; D010871:Pinealoma / Q000209:etiology* / Q000401:mortality; D012189:Retrospective Studies