Anaplastic glioma after high-dose proton–photon radiation treatment for low-grade skull base chondrosarcoma


We report the case of a 63-year-old man who developed an anaplastic oligoastrocytoma of the brain stem and midbrain 13 years after postoperative high-dose proton–photon radiation therapy for a recurrent low-grade chondrosarcoma of the skull base. To our knowledge, this is the first reported case of an anaplastic glioma after proton–photon irradiation.

This is a preview of subscription content, log in to check access.

Fig. 1
Fig. 2
Fig. 3


  1. 1.

    Liwnicz B, Berger T, Liwnicz R, Aron B (1985) Radiation-associated gliomas: a report of four cases and analysis of postradiation tumors of the central nervous system. Neurosurgery 17:436–445

    PubMed  Article  CAS  Google Scholar 

  2. 2.

    Riffaud L, Bernard M, Lesimple T, Morandi X (2006) Radiation-induced spinal cord glioma subsequent to treatment of Hodgkin's disease: case report and review. J Neurooncol 76:207–211

    PubMed  Article  Google Scholar 

  3. 3.

    Romeike B, Kim Y, Steudel W, Graf N (2007) Diffuse high-grade gliomas as second malignant neoplasms after radio-chemotherapy for pediatric malignancies. Childs Nerv Syst 23:185–193

    PubMed  Article  Google Scholar 

  4. 4.

    Salvati M, Frati A, Russo N, Caroli E, Polli F, Minniti G, Delfini R (2003) Radiation-induced gliomas: report of 10 cases and review of the literature. Surg Neurol 60:60–67

    PubMed  Article  Google Scholar 

  5. 5.

    Yang S, Wang K, Cho B, Kim Y, Lim S, Park S, Kim I, Kim S (2005) Radiation-induced cerebellar glioblastoma at the site of a treated medulloblastoma: case report. J Neurosurg 102:417–422

    PubMed  CAS  Google Scholar 

  6. 6.

    Yeung Y, Wong G, Zhu X, Ma B, Hk N, Poon W (2006) Radiation-induced spinal glioblastoma multiforme. Acta Oncol 45:87–90

    PubMed  Article  CAS  Google Scholar 

  7. 7.

    Brackmann D, Teufert K (2006) Chondrosarcoma of the skull base: long-term follow-up. Otol Neurotol 27:981–991

    PubMed  Article  Google Scholar 

  8. 8.

    Noël G, Feuvret L, Calugaru V, Dhermain F, Mammar H, Haie-Méder C, Ponvert D, Hasboun D, Ferrand R, Nauraye C, Boisserie G, Beaudré A, Gaboriaud G, Mazal A, Habrand J, Mazeron J (2005) Chordomas of the base of the skull and upper cervical spine. One hundred patients irradiated by a 3D conformal technique combining photon and proton beams. Acta Oncol 44:700–708

    PubMed  Article  Google Scholar 

  9. 9.

    Santoni R, Liebsch N, Finkelstein D, Hug E, Hanssens P, Goitein M, Smith A, O'Farrell D, Efird J, Fullerton B, Munzenrider J (1998) Temporal lobe (TL) damage following surgery and high-dose photon and proton irradiation in 96 patients affected by chordomas and chondrosarcomas of the base of the skull. Int J Radiat Oncol Biol Phys 41:59–68

    PubMed  CAS  Google Scholar 

  10. 10.

    Krengli M, Liebsch N, Hug E, Orecchia R (1998) Review of current protocols for protontherapy in USA. Tumori 84:209–216

    PubMed  CAS  Google Scholar 

  11. 11.

    World Health Organisation classification of tumours (2000) Pathology and genetics of tumours of the nervous system. IARC Press, Lyon

    Google Scholar 

  12. 12.

    Hatanpaa K, Burger P, Eshleman J, Murphy K, Berg K (2003) Molecular diagnosis of oligodendroglioma in paraffin sections. Lab Invest 83:419–428

    PubMed  CAS  Google Scholar 

  13. 13.

    WHO (2007) Classification of Tumours of the Central Nervous System. IARC, Lyon

    Google Scholar 

  14. 14.

    Aldape K, Burger P, Perry A (2007) Clinicopathologic aspects of 1p/19q loss and the diagnosis of oligodendroglioma. Arch Pathol Lab Med 131:242–251

    PubMed  CAS  Google Scholar 

  15. 15.

    Choudhary A, Pradhan S, Huda M, Mohanty S, Kumar M (2006) Radiation induced meningioma with a short latent period following high dose cranial irradiation—case report and literature review. J Neurooncol 77:73–77

    PubMed  Article  Google Scholar 

  16. 16.

    Piccirilli M, di Norcia V, Frati A, Salvati M (2005) Glioblastoma in irradiated elderly patients: two case reports. Neurosurg Rev 28:226–228

    PubMed  Article  Google Scholar 

  17. 17.

    Bondy M, Wang L, El-Zein R, de Andrade M, Selvan M, Bruner J, Levin V, Alfred Yung W, Adatto P, Wei Q (2001) Gamma-radiation sensitivity and risk of glioma. J Natl Cancer Inst 93:1553–1557

    PubMed  CAS  Article  Google Scholar 

  18. 18.

    Cahan W, Woodard H, Higinbotham N, Stewart F, Coley B (1948) Sarcoma arising in irradiated bone: report of eleven cases. Cancer 1:3–29

    Article  CAS  PubMed  Google Scholar 

  19. 19.

    Watanabe T, Fuse T, Umezu M, Yamamoto M, Demura K, Niwa Y (2006) Radiation-induced osteosarcoma 16 years after surgery and radiation for glioma--case report. Neurol Med Chir (Tokyo) 46:51–54

    Article  Google Scholar 

  20. 20.

    Brat D, James C, Jedlicka A, Connolly D, Chang E, Castellani R, Schmid M, Schiller M, Carson D, Burger P (1999) Molecular genetic alterations in radiation-induced astrocytomas. Am J Pathol 154:1431–1438

    PubMed  CAS  Google Scholar 

  21. 21.

    Levin W, Kooy H, Loeffler J, DeLaney T (2005) Proton beam therapy. Br J Cancer 93:849–854

    PubMed  Article  CAS  Google Scholar 

  22. 22.

    Schneider U, Lomax A, Hauser B, Kaser-Hotz B (2006) Is the risk for secondary cancers after proton therapy enhanced distal to the Planning Target Volume? A two-case report with possible explanations. Radiat Environ Biophys 45:39–43

    PubMed  Article  Google Scholar 

  23. 23.

    Noël G, Habrand J, Mammar H, Pontvert D, Haie-Méder C, Hasboun D, Moisson P, Ferrand R, Beaudré A, Boisserie G, Gaboriaud G, Mazal A, Kérody K, Schlienger M, Mazeron J (2001) Combination of photon and proton radiation therapy for chordomas and chondrosarcomas of the skull base: the Centre de Protonthérapie D'Orsay experience. Int J Radiat Oncol Biol Phys 51:392–398

    PubMed  Google Scholar 

  24. 24.

    Noël G, Habrand J, Jauffret E, de Crevoisier R, Dederke S, Mammar H, Haie-Méder C, Pontvert D, Hasboun D, Ferrand R, Boisserie G, Beaudré A, Gaboriaud G, Guedea F, Petriz L, Mazeron J (2003) Radiation therapy for chordoma and chondrosarcoma of the skull base and the cervical spine. Prognostic factors and patterns of failure. Strahlenther Onkol 179:241–248

    PubMed  Article  Google Scholar 

Download references

Author information



Corresponding author

Correspondence to Tim-Rasmus Kiehl.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Ehsani, S., Hodaie, M., Liebsch, N.J. et al. Anaplastic glioma after high-dose proton–photon radiation treatment for low-grade skull base chondrosarcoma. J Neurooncol 88, 231–236 (2008).

Download citation


  • Anaplastic glioma
  • Brain tumor
  • Oligoastrocytoma
  • Proton radiation therapy
  • Radiation-associated tumor
  • Skull base chondrosarcoma