Child's Nervous System

, Volume 22, Issue 9, pp 1201–1207 | Cite as

Metachronous secondary atypical meningioma and anaplastic astrocytoma after postoperative craniospinal irradiation for medulloblastoma

  • Andrew J. Hope
  • David B. Mansur
  • Pang-Hsien Tu
  • Joseph R. Simpson
Case Report



Malignant brain tumors have been reported to occur after childhood irradiation more frequently than in the nonirradiated population.


In this study, we report the case of a 15-year-old boy treated for medulloblastoma with surgery and craniospinal radiotherapy, who developed a meningioma 18 years after initial treatment and subsequently an anaplastic astrocytoma 23 years after primary treatment. The meningioma was resected without complications. The patient is currently alive but with recurrent astrocytoma after a complete remission on temozolomide monotherapy. Second malignancies are a rare, potentially devastating risk in cancer survivors, with risk continuing lifelong.


Second malignancy Medulloblastoma Astrocytoma Meningioma Radiation 


Conflict of interest

The authors have no conflicts of interest to declare.


  1. 1.
    Davis FG, McCarthy BJ, Freels S et al (1999) The conditional probability of survival of patients with primary malignant brain tumors: surveillance, epidemiology, and end results (SEER) data. Cancer 85:485–491CrossRefPubMedGoogle Scholar
  2. 2.
    Stavrou T, Bromley CM, Nicholson HS et al (2001) Prognostic factors and secondary malignancies in childhood medulloblastoma. J Pediatr Hematol Oncol 23:431–436CrossRefPubMedGoogle Scholar
  3. 3.
    Nakamizo A, Nishio S, Inamura T et al (2001) Evolution of malignant cerebellar astrocytoma at the site of a treated medulloblastoma: report of two cases. Acta Neurochir (Wien) 143:697–700CrossRefGoogle Scholar
  4. 4.
    Strojan P, Popovic M, Jereb B (2000) Secondary intracranial meningiomas after high-dose cranial irradiation: report of five cases and review of the literature. Int J Radiat Oncol Biol Phys 48:65–73CrossRefPubMedGoogle Scholar
  5. 5.
    Olsen JH, Garwicz S, Hertz H (1993) Second malignant neoplasms after cancer in childhood or adolescence. Nordic Society of Paediatric Haematology and Oncology Association of the Nordic Cancer Registries. Br Med J 307:1030–1036CrossRefGoogle Scholar
  6. 6.
    Neglia JP, Friedman DL, Yasui Y (2001) Second malignant neoplasms in five-year survivors of childhood cancer: childhood cancer survivor study. J Natl Cancer Inst 93:618–629CrossRefPubMedGoogle Scholar
  7. 7.
    Anderson JR, Treip CS (1984) Radiation-induced intracranial neoplasms. A report of three possible cases. Cancer 53:426–429PubMedCrossRefGoogle Scholar
  8. 8.
    Bachman DS, Ostrow PT (1978) Fatal long-term sequela following radiation “cure” for ependymoma. Ann Neurol 4:319–321CrossRefPubMedGoogle Scholar
  9. 9.
    Kaschten B, Flandroy P, Reznik M (1995) Radiation-induced gliosarcoma. Case report and review of the literature. J Neurosurg 83:154–162PubMedGoogle Scholar
  10. 10.
    Cahan WG, Woodard HQ, Higinbotham NL (1998) Sarcoma arising in irradiated bone: report of eleven cases. Cancer 82:8–34CrossRefPubMedGoogle Scholar
  11. 11.
    Chang SM, Barker FGn, Larson DA (1995) Sarcomas subsequent to cranial irradiation. Neurosurgery 36:685–690PubMedCrossRefGoogle Scholar
  12. 12.
    Albert RE, Omran AR, Brauer EW (1966) Follow-up study of patients treated by X-ray for tinea capitis. Am J Pub Health Nation’s Health 56:2114–2120CrossRefGoogle Scholar
  13. 13.
    Modan B, Biadatz D, Mart H (1974) Radiation-induced head and neck tumours. Lancet 1:277–279CrossRefPubMedGoogle Scholar
  14. 14.
    Tokars RP, Sutton HG, Griem ML (1979) Cerebellar medulloblastoma: results of a new method of radiation treatment. Cancer 43:129–136PubMedCrossRefGoogle Scholar
  15. 15.
    Goldstein AM, Yuen J, Tucker MA (1997) Second cancers after medulloblastoma: population-based results from the United States and Sweden. Cancer Causes Control 8:865–871CrossRefPubMedGoogle Scholar
  16. 16.
    Salvati M, Cervoni L, Puzzilli F (1997) High-dose radiation-induced meningiomas. Surg Neurol 47:341–432 (Discussion)CrossRefGoogle Scholar
  17. 17.
    Shintani T, Hayakawa N, Kamada N (1997) High incidence of meningioma in survivors of Hiroshima. Lancet 349:1369CrossRefPubMedGoogle Scholar
  18. 18.
    Ron E, Modan B, Boice JD Jr, et al (1988) Tumors of the brain and nervous system after radiotherapy in childhood. N Engl J Med 319:1033–1039PubMedCrossRefGoogle Scholar
  19. 19.
    Zochodne DW, Cairncross JG, Arce FP et al (1984) Astrocytoma following scalp radiotherapy in infancy. Can J Neurol Sci 11:475–478PubMedGoogle Scholar
  20. 20.
    Picard L, Almeras M, Delgoffe C et al (1983) Medulloblastomas and retinoblastomas. CT images of intracranial meningeal metastases. J Neuroradiol 10:43–49PubMedGoogle Scholar
  21. 21.
    Hufnagel TJ, Kim JH, Lesser R et al (1988) Malignant glioma of the optic chiasm eight years after radiotherapy for prolactinoma. Arch Ophthalmol 106:1701–1705PubMedGoogle Scholar
  22. 22.
    Kitanaka C, Shitara N, Nakagomi T et al (1989) Postradiation astrocytoma. Report of two cases. J Neurosurg 70:469–474PubMedGoogle Scholar
  23. 23.
    Rittinger O, Kranzinger M, Jones R et al (2003) Malignant astrocytoma arising 10 years after combined treatment of craniopharyngioma. J Pediatr Endocrinol Metab 16:97–101PubMedGoogle Scholar
  24. 24.
    Kranzinger M, Jones N, Rittinger O et al (2001) Malignant glioma as a secondary malignant neoplasm after radiation therapy for craniopharyngioma: report of a case and review of reported cases. Onkologie 24:66–72CrossRefPubMedGoogle Scholar
  25. 25.
    Sogg RL, Donaldson SS, Yorke CH (1978) Malignant astrocytoma following radiotherapy of a craniopharyngoima. Case report. J Neurosurg 48:622–627PubMedGoogle Scholar
  26. 26.
    Salvati M, Frati A, Russo N et al (2003) Radiation-induced gliomas: report of 10 cases and review of the literature. Surg Neurol 60:60–67 (Discussion 67)CrossRefPubMedGoogle Scholar
  27. 27.
    Walter AW, Hancock ML, Pui CH et al (1998) Secondary brain tumors in children treated for acute lymphoblastic leukemia at St Jude Children’s Research Hospital. J Clin Oncol 16:3761–3767PubMedGoogle Scholar
  28. 28.
    Hamilton SR, Liu B, Parsons RE et al (1995) The molecular basis of Turcot’s syndrome. N Engl J Med 332:839–847CrossRefPubMedGoogle Scholar
  29. 29.
    Amirjamshidi A, Abbassioun K (2000) Radiation-induced tumors of the central nervous system occurring in childhood and adolescence. Four unusual lesions in three patients and a review of the literature. Childs Nerv Syst 16:390–397CrossRefPubMedGoogle Scholar
  30. 30.
    Alexander MJ, DeSalles AA, Tomiyasu U (1998) Multiple radiation-induced intracranial lesions after treatment for pituitary adenoma. Case Report. J Neurosurg 88:111–115PubMedCrossRefGoogle Scholar
  31. 31.
    Kleriga E, Sher JH, Nallainathan SK et al (1978) Development of cerebellar malignant astrocytoma at site of a medulloblastoma treated 11 years earlier. Case report. J Neurosurg 49:445–449PubMedGoogle Scholar
  32. 32.
    Pearl GS, Mirra SS, Miles ML (1980) Glioblastoma multiforme occurring 13 years after treatment of a medulloblastoma. Neurosurgery 6:546–551PubMedCrossRefGoogle Scholar
  33. 33.
    Cohen MS, Kushner MJ, Dell S (1981) Frontal lobe astrocytoma following radiotherapy for medulloblastoma. Neurology 31:616–619PubMedGoogle Scholar
  34. 34.
    Schmidbauer M, Budka H, Bruckner R et al (1987) Glioblastoma developing at the site of a cerebellar medulloblastoma treated 6 years earlier. Case report. J Neurosurg 67:915–918PubMedCrossRefGoogle Scholar
  35. 35.
    Safneck JR, Napier LB, Halliday WC (1992) Malignant astrocytoma of the optic nerve in a child. Can J Neurol Sci 19:498–503PubMedGoogle Scholar
  36. 36.
    Osumi AK, McLendon RE, Tien RD et al (1994) Well differentiated astrocytoma occurring nine years after radiation therapy for medulloblastoma. Clin Neuropathol 13:281–285PubMedGoogle Scholar
  37. 37.
    Grabb PA, Kelly DR, Fulmer BB et al (1996) Radiation-induced glioma of the spinal cord. Pediatr Neurosurg 25:214–219PubMedCrossRefGoogle Scholar
  38. 38.
    Furuta T, Sugiu K, Tamiya T et al (1998) Malignant cerebellar astrocytoma developing 15 years after radiation therapy for a medulloblastoma. Clin Neurol Neurosurg 100:56–59CrossRefPubMedGoogle Scholar
  39. 39.
    Van Calenbergh F, D’Haen B, Dom R et al (1999) Secondary supratentorial anaplastic astrocytoma following treatment of medulloblastoma. Eur J Paediatr Neurol 3:177–180CrossRefPubMedGoogle Scholar
  40. 40.
    Malde R, Jalali R, Muzumdar D et al (2003) Gliosarcoma occurring 8 years after treatment for a medulloblastoma. Childs Nerv Syst 20(40):243–246CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag 2006

Authors and Affiliations

  • Andrew J. Hope
    • 1
  • David B. Mansur
    • 1
  • Pang-Hsien Tu
    • 2
  • Joseph R. Simpson
    • 1
  1. 1.Department of Radiation OncologyWashington University School of MedicineSt. LouisUSA
  2. 2.Department of Pathology and ImmunologyWashington University School of MedicineSt. LouisUSA

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