Survivors of Childhood Cancer: Risk of Glioma and Meningioma Following Radiotherapy
Pediatric cancer survival rates have improved significantly over the past several decades as advances have been made in both therapies and supportive care. Improved survival rates have been accompanied by increased recognition of therapy-related late effects, such as second neoplasms. Two of the most common classes of pediatric cancers include acute leukemias and tumors of the central nervous system, both of which have historically involved CNS-directed radiation therapy. Through multiple childhood cancer survivor cohorts, it has been recognized that survivors previously treated with radiation to the central nervous system are at increased risk for developing secondary gliomas and meningiomas, both of which have been shown to occur at well-defined time points and in a dose-responsive fashion. Based on these findings, current era treatment protocols have been modified to minimize toxicity and reduce the use of radiation when possible. Long term follow up of cancer survivors remains an imperative part of their ongoing care given the long latency period that has been observed to development of secondary CNS tumors.
KeywordsCentral Nervous System Tumor Cranial Radiation Childhood Cancer Survivor Tinea Capitis Central Nervous System Relapse
This work was supported by the Children’s Cancer Research Fund, Minneapolis, MN and the National Institutes of Health Pediatric Cancer Epidemiology Training Grant T32 CA099936.
- Altekruse SF, Kosary CL, Krapcho M, Neyman N, Aminou R, Waldron W, Ruhl J, Howlader N, Tatalovich Z, Cho H, Mariotto A, Eisner MP, Lewis DR, Cronin K, Chen HS, Feuer EJ, Stinchcomb DG, Edwards BK (eds) (2010) SEER cancer statistics review, 1975–2007. National Cancer Institute, Bethesda, http://seer.cancer.gov/csr/1975_2007/, based on November 2009 SEER data submission, posted to the SEER web siteGoogle Scholar
- Children’s Cancer and Leukaemia Group (CCLG) (2005) Therapy based long term follow up guidelines (Secondary malignancy). www.cclg.org.uk/library/19/PracticeStatement?LTFU-full.pdf
- Children’s Oncology Group (COG) (2008) Long-term follow-up guidelines for survivors of childhood, adolescent, and young adult cancers. http://www.survivorshipguidelines.org/pdf/LTFUGuidelines.pdf
- Hudson MM, Neglia JP, Woods WG, Sandlund JT, Pui C-H, Kun LE, Robison LL, Green DM (2012) Lessons from the past: opportunities to improve childhood cancer survivor care through outcomes investigations of historical therapeutic approaches for pediatric hematological malignancies. Pediatr Blood Cancer 58:334–343PubMedCentralPubMedCrossRefGoogle Scholar
- Neglia JP, Robison LL, Stovall M, Liu Y, Packer RJ, Hammond S, Yasui Y, Kasper CE, Mertens AC, Donaldson SS, Meadows AT, Inskip PD (2006) New primary neoplasms of the central nervous system in survivors of childhood cancer: a report from the Childhood Cancer Survivor Study. J Natl Cancer Inst 98:1528–1537PubMedCrossRefGoogle Scholar
- Packer RJ, Gajjar A, Vezina G, Rorke-Adams L, Burger PC, Robertson PL, Bayer L, LaFond D, Donahue BR, Marymont MH, Muraszko K, Langston J, Sposto R (2006) Phase III study of craniospinal radiation therapy followed by adjuvant chemotherapy for newly diagnosed average-risk medulloblastoma. J Clin Oncol 24:4202–4208PubMedCrossRefGoogle Scholar
- Pui C-H, Mahmoud HH, Rivera GK, Hancock ML, Sandlund JT, Behm FG, Head DR, Relling MV, Ribiero RC, Rubnitz JE, Kun LE, Evans WE (1998) Early intensification of intrathecal chemotherapy virtually eliminates central nervous system relapse in children with acute lymphoblastic leukemia. Blood 92:411–415PubMedGoogle Scholar
- Taylor AJ, Frobisher C, Ellison DW, Reulen RC, Winter DL, Taylor RE, Stiller CA, Lancashire ER, Tudor ECG, Baggott C, May S, Hawkins MM (2009) Survival after second primary neoplasms of the brain or spinal cord in survivors of childhood cancer: results from the British Childhood Cancer Survivor Study. J Clin Oncol 34:5781–5787CrossRefGoogle Scholar
- Taylor AJ, Little MP, Winter DL, Sugden E, Ellison DW, Stiller CA, Stovall M, Frobisher C, Lancashire ER, Reulen RC, Hawkins MM (2010) Population-based risks of CNS tumors in survivors of childhood cancer: the British Childhood Cancer Survivor Study. J Clin Oncol 28:5287–5293PubMedCrossRefGoogle Scholar