title: Radiation-induced malignant meningioma following proton beam therapy for a choroidal melanoma.
abstract: We report a woman with malignant meningioma diagnosed 9 years after the treatment of a choroidal melanoma with proton beam therapy. The risk of secondary cancers is a well-known adverse late effect of radiation therapy, especially with the use of advanced techniques such as intensity-modulated radiation therapy. However, this risk may be less with the use of proton beam therapy. A 79-year-old woman presented with symptoms of enophthalmos, ptosis and paralysis of the left medial rectus muscle. She had previously been successfully treated for a choroidal melanoma of the left eye with proton beam therapy (total dose: 60 cobalt gray equivalents) following local resection. MRI showed a lesion in the left cavernous sinus with extension into the orbit and a subsequent biopsy revealed a papillary meningioma. The cavernous tumor was treated with photon radiotherapy (total dose: 54Gy) which achieved an initial partial response. However, 8 months later the tumor extensively metastasized to the skull and the spine and the patient died 1 year after the treatment. The incidence of secondary malignancies after proton beam therapy is low but not negligible, therefore, it must be taken into account when planning a treatment as secondary tumors may present with a highly aggressive behaviour.
authors: Radiation Oncology Unit, Sant' Andrea Hospital, University Sapienza, Via Grottarossa 1035, Rome 00189, Italy. Electronic address: clascaringi@gmail.com.
authors: Claudia
authors: C
authors: Scaringi
authors: Radiation Oncology Unit, Sant' Andrea Hospital, University Sapienza, Via Grottarossa 1035, Rome 00189, Italy; IRCCS Neuromed, Pozzilli, Italy.
authors: Giuseppe
authors: G
authors: Minniti
authors: Neuroradiology Unit, Sant' Andrea Hospital, University Sapienza, Rome, Italy.
authors: Alessandro
authors: A
authors: Bozzao
authors: IRCCS Neuromed, Pozzilli, Italy.
authors: Felice
authors: F
authors: Giangaspero
authors: Radiation Oncology Unit, Sant' Andrea Hospital, University Sapienza, Via Grottarossa 1035, Rome 00189, Italy.
authors: Teresa
authors: T
authors: Falco
authors: Radiation Oncology Unit, Sant' Andrea Hospital, University Sapienza, Via Grottarossa 1035, Rome 00189, Italy.
authors: Alessandro
authors: A
authors: Greco
authors: Radiation Oncology Unit, Sant' Andrea Hospital, University Sapienza, Via Grottarossa 1035, Rome 00189, Italy.
authors: Vitaliana
authors: V
authors: De Sanctis
authors: Neuroradiology Unit, Sant' Andrea Hospital, University Sapienza, Rome, Italy.
authors: Andrea
authors: A
authors: Romano
authors: Radiation Oncology Unit, Sant' Andrea Hospital, University Sapienza, Via Grottarossa 1035, Rome 00189, Italy.
authors: Riccardo Maurizi
authors: RM
authors: Enrici
mesh_terms: D000368:Aged; D002830:Choroid Neoplasms / Q000532:radiotherapy*; D005260:Female; D006801:Humans; D008545:Melanoma / Q000532:radiotherapy*; D008579:Meningioma / Q000209:etiology* / Q000473:pathology*; D009381:Neoplasms, Radiation-Induced / Q000209:etiology* / Q000473:pathology*; D061766:Proton Therapy / Q000009:adverse effects*; D014604:Uveal Neoplasms / Q000532:radiotherapy*; D000098943:Uveal Melanoma
keywords: Proton beam therapy; Radiation-induced meningioma; Secondary cancers