Morbidity and Mortality Associated With Meningioma After Cranial Radiotherapy: A Report From the Childhood Cancer Survivor Study.
Purpose Little is known about neurologic morbidity attributable to cranial radiotherapy (CRT) -associated meningiomas. Materials and Methods From 4,221 survivors exposed to CRT in the Childhood Cancer Survivor Study, a diagnosis of meningioma and onset of neurologic sequelae were ascertained. Cox proportional hazards regression was used to estimate hazard ratios (HR) and 95% CIs to evaluate the factors associated with neurologic sequelae after subsequent meningioma. Results One hundred ninety-nine meningiomas were identified among 169 participants. The median interval from primary cancer to meningioma diagnosis was 22 years (5 to 37 years). The cumulative incidence of a subsequent meningioma by age 40 years was 5.6% (95% CI, 4.7% to 6.7%). CRT doses of 20 to 29.9 Gy (HR, 1.6; 95% CI,1.0 to 2.6) and doses ≥ 30 Gy (HR, 2.6; 95% CI, 1.6 to 4.2) were associated with an increased risk of meningioma compared with CRT doses of 1.5 to 19.9 Gy ( P < .001). Within 6 months before or subsequent to a meningioma diagnosis, 20% (30 of 149) reported at least one new neurologic sequela, including seizures (8.3%), auditory-vestibular-visual deficits (6%), focal neurologic dysfunction (7.1%), and severe headaches (5.3%). Survivors reporting a meningioma had increased risks of neurologic sequelae > 5 years after primary cancer diagnosis, including seizures (HR, 10.0; 95% CI, 7.0 to 15.3); auditory-vestibular-visual sensory deficits (HR, 2.3; 95% CI, 1.3 to 4.0); focal neurologic dysfunction (HR, 4.9; 95% CI, 3.2 to 7.5); and severe headaches (HR, 3.2; 95% CI, 1.9 to 5.4). With a median follow-up of 72 months after meningioma diagnosis (range, 3.8 to 395 months), 22 participants (13%) were deceased, including six deaths attributed to a meningioma. Conclusion Childhood cancer survivors exposed to CRT and subsequently diagnosed with a meningioma experience significant neurologic morbidity.
Daniel C. Bowers, UT Southwestern Medical Center, Dallas, TX; Chaya S. Moskowitz, Joanne F. Chou, and Kevin C. Oeffinger, Memorial Sloan Kettering Cancer Center, New York, NY; Claire M. Mazewski, Emory University, Atlanta, GA; Joseph P. Neglia, University of Minnesota, Minneapolis, MN; Gregory T. Armstrong and Leslie L. Robison, St. Jude Children's Research Hospital, Memphis, TN; and Wendy M. Leisenring, Fred Hutchinson Cancer Research Center, Seattle, WA.
Daniel C
DC
Bowers
Daniel C. Bowers, UT Southwestern Medical Center, Dallas, TX; Chaya S. Moskowitz, Joanne F. Chou, and Kevin C. Oeffinger, Memorial Sloan Kettering Cancer Center, New York, NY; Claire M. Mazewski, Emory University, Atlanta, GA; Joseph P. Neglia, University of Minnesota, Minneapolis, MN; Gregory T. Armstrong and Leslie L. Robison, St. Jude Children's Research Hospital, Memphis, TN; and Wendy M. Leisenring, Fred Hutchinson Cancer Research Center, Seattle, WA.
Chaya S
CS
Moskowitz
Daniel C. Bowers, UT Southwestern Medical Center, Dallas, TX; Chaya S. Moskowitz, Joanne F. Chou, and Kevin C. Oeffinger, Memorial Sloan Kettering Cancer Center, New York, NY; Claire M. Mazewski, Emory University, Atlanta, GA; Joseph P. Neglia, University of Minnesota, Minneapolis, MN; Gregory T. Armstrong and Leslie L. Robison, St. Jude Children's Research Hospital, Memphis, TN; and Wendy M. Leisenring, Fred Hutchinson Cancer Research Center, Seattle, WA.
Joanne F
JF
Chou
Daniel C. Bowers, UT Southwestern Medical Center, Dallas, TX; Chaya S. Moskowitz, Joanne F. Chou, and Kevin C. Oeffinger, Memorial Sloan Kettering Cancer Center, New York, NY; Claire M. Mazewski, Emory University, Atlanta, GA; Joseph P. Neglia, University of Minnesota, Minneapolis, MN; Gregory T. Armstrong and Leslie L. Robison, St. Jude Children's Research Hospital, Memphis, TN; and Wendy M. Leisenring, Fred Hutchinson Cancer Research Center, Seattle, WA.
Claire M
CM
Mazewski
Daniel C. Bowers, UT Southwestern Medical Center, Dallas, TX; Chaya S. Moskowitz, Joanne F. Chou, and Kevin C. Oeffinger, Memorial Sloan Kettering Cancer Center, New York, NY; Claire M. Mazewski, Emory University, Atlanta, GA; Joseph P. Neglia, University of Minnesota, Minneapolis, MN; Gregory T. Armstrong and Leslie L. Robison, St. Jude Children's Research Hospital, Memphis, TN; and Wendy M. Leisenring, Fred Hutchinson Cancer Research Center, Seattle, WA.
Joseph P
JP
Neglia
Daniel C. Bowers, UT Southwestern Medical Center, Dallas, TX; Chaya S. Moskowitz, Joanne F. Chou, and Kevin C. Oeffinger, Memorial Sloan Kettering Cancer Center, New York, NY; Claire M. Mazewski, Emory University, Atlanta, GA; Joseph P. Neglia, University of Minnesota, Minneapolis, MN; Gregory T. Armstrong and Leslie L. Robison, St. Jude Children's Research Hospital, Memphis, TN; and Wendy M. Leisenring, Fred Hutchinson Cancer Research Center, Seattle, WA.
Gregory T
GT
Armstrong
Daniel C. Bowers, UT Southwestern Medical Center, Dallas, TX; Chaya S. Moskowitz, Joanne F. Chou, and Kevin C. Oeffinger, Memorial Sloan Kettering Cancer Center, New York, NY; Claire M. Mazewski, Emory University, Atlanta, GA; Joseph P. Neglia, University of Minnesota, Minneapolis, MN; Gregory T. Armstrong and Leslie L. Robison, St. Jude Children's Research Hospital, Memphis, TN; and Wendy M. Leisenring, Fred Hutchinson Cancer Research Center, Seattle, WA.
Wendy M
WM
Leisenring
Daniel C. Bowers, UT Southwestern Medical Center, Dallas, TX; Chaya S. Moskowitz, Joanne F. Chou, and Kevin C. Oeffinger, Memorial Sloan Kettering Cancer Center, New York, NY; Claire M. Mazewski, Emory University, Atlanta, GA; Joseph P. Neglia, University of Minnesota, Minneapolis, MN; Gregory T. Armstrong and Leslie L. Robison, St. Jude Children's Research Hospital, Memphis, TN; and Wendy M. Leisenring, Fred Hutchinson Cancer Research Center, Seattle, WA.
Leslie L
LL
Robison
Daniel C. Bowers, UT Southwestern Medical Center, Dallas, TX; Chaya S. Moskowitz, Joanne F. Chou, and Kevin C. Oeffinger, Memorial Sloan Kettering Cancer Center, New York, NY; Claire M. Mazewski, Emory University, Atlanta, GA; Joseph P. Neglia, University of Minnesota, Minneapolis, MN; Gregory T. Armstrong and Leslie L. Robison, St. Jude Children's Research Hospital, Memphis, TN; and Wendy M. Leisenring, Fred Hutchinson Cancer Research Center, Seattle, WA.
Kevin C
KC
Oeffinger
D000293:Adolescent; D000328:Adult; D002170:Canada / Q000453:epidemiology; D002648:Child; D016371:Cranial Irradiation / Q000009:adverse effects; D005260:Female; D005500:Follow-Up Studies; D006261:Headache / Q000209:etiology; D006311:Hearing Disorders / Q000209:etiology; D006801:Humans; D015994:Incidence; D008137:Longitudinal Studies; D008297:Male; D008577:Meningeal Neoplasms / Q000150:complications* / Q000453:epidemiology* / Q000401:mortality; D008579:Meningioma / Q000150:complications* / Q000453:epidemiology* / Q000401:mortality; D008875:Middle Aged; D009381:Neoplasms, Radiation-Induced / Q000150:complications* / Q000453:epidemiology* / Q000401:mortality; D016609:Neoplasms, Second Primary / Q000150:complications* / Q000453:epidemiology* / Q000401:mortality; D016016:Proportional Hazards Models; D011879:Radiotherapy Dosage; D012189:Retrospective Studies; D012307:Risk Factors; D012640:Seizures / Q000209:etiology; D014481:United States / Q000453:epidemiology; D015837:Vestibular Diseases / Q000209:etiology; D014786:Vision Disorders / Q000209:etiology; D055815:Young Adult