Radiation-Induced Meningiomas

Department of Neurosurgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel. umansky@hadassah
Neurosurgical FOCUS (Impact Factor: 2.11). 02/2008; 24(5):E7. DOI: 10.3171/FOC/2008/24/5/E7
Source: PubMed


The long-term or delayed side effects of irradiation on neural tissue are now known to include the induction of new central nervous system neoplasms. However, during the first half of the 20th century, human neural tissue was generally considered relatively resistant to the carcinogenic and other ill effects of ionizing radiation. As a result, exposure to relatively high doses of x-rays from diagnostic examinations and therapeutic treatment was common. In the present article the authors review the literature relating to radiation-induced meningiomas (RIMs). Emphasis is placed on meningiomas resulting from childhood treatment for primary brain tumor or tinea capitis, exposure to dental x-rays, and exposure to atomic explosions in Hiroshima and Nagasaki. The incidence and natural history of RIMs following exposure to high- and low-dose radiation is presented, including latency, multiplicity, histopathological features, and recurrence rates. The authors review the typical presentation of patients with RIMs and discuss unique aspects of the surgical management of these tumors compared with sporadic meningioma, based on their clinical experience in treating these lesions.

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    • "Patients with RIMs are typically divided into those with histories of low, medium, and high dose radiation [5]. As discussed briefly above, some suggest that patients with a prior history of high dose radiation are more likely to present with higher grade lesions and have a greater likelihood of recurrence [3–5, 11, 29, 30, 34, 36–38]. Therefore, following surgical resection, this cohort of patients is more likely to require adjuvant therapy particularly if a Simpson I resection has not been obtained. "
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    ABSTRACT: Meningiomas are among the most common primary adult brain tumors, which arise either spontaneously or secondary to environmental factors such as ionizing radiation. The latter are referred to as radiation-induced meningiomas (RIMs) which, while much less common than their spontaneous counterparts, are challenging from a management point of view. Similar to spontaneous meningiomas, the optimal management of RIMs is complete surgical resection. However, given their high grade, multiplicity, tendency to invade bone and venous sinuses, and high recurrence rate, this cannot always be accomplished safely. Therefore, other therapeutic modalities, such as stereotactic radiosurgery, have emerged. In the current review, we provide an overview of the historical outcomes achieved for RIMs through radiosurgery and microsurgical resection. Furthermore, we provide a discussion of clinical and radiological parameters that affect the decision-making process with regard to the management of RIMs. We also provide an outline of recent changes in our understanding of RIMs, based on molecular and genetic markers, and how these will change our management perspective. We conclude the review by summarizing some of the current obstacles in the management of RIMs with SRS and how current and future research can address these challenges.
    BioMed Research International 07/2014; 2014:107526. DOI:10.1155/2014/107526 · 3.17 Impact Factor
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    • "Another report estimated that nearly 16% of RIM cases have multiple mass lesions [11] and a higher rate of atypical or aggressive forms. Al-Mefty et al. reported that approximately 31% of RIM cases were atypical meningiomas with a higher recurrence rate [12], which was also suggested by several other investigators [13,14]. A pathological study of RIMs revealed that RIMs presented with more malignant features than SMs, namely, hypercellularity, pleomorphism, increased mitotic figures, and necrotic changes [15,16]. "
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    ABSTRACT: Combined chemotherapy and prophylactic cranial irradiation has improved the prognosis of children with acute leukemia. However cranial irradiation carries a latent risk of the induction of secondary intracranial tumors. We encountered a patient who developed multiple intracranial radiation-induced meningiomas (RIMs) 25 years after prophylactic cranial irradiation for the treatment of acute leukemia in childhood. The patient had 3 intracranial lesions, 1 of which showed rapid growth within 6 months; another of the tumors also enlarged within a short period. All of the tumors were surgically treated, and immunohistochemistry indicated a high MIB-1 labeling index in each of the multiple lesions. In the literature, the MIB-1 labeling indices of 27 tumors from 21 patients were examined. Among them, 12 recurrent tumors showed higher MIB-1 labeling indices compared to the MIB-1 labeling indices of the non-recurrent tumors. Overall, 11 of the patients with RIM had multiple lesions and 8 cases developed recurrence (72.7%). RIM cases with multiple lesions had higher MIB-1 labeling indices compared to the MIB-1 labeling indices of cases with single lesions. Collectively, these data showed that the MIB-1 labeling index is as important for predicting RIM recurrences, as it is for predicting sporadic meningioma (SM) recurrences. RIMs should be treated more aggressively than SMs because of their greater malignant potential.
    World Journal of Surgical Oncology 04/2014; 12(1):123. DOI:10.1186/1477-7819-12-123 · 1.41 Impact Factor
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    • "The options include watch and wait with serial scanning for asymptomatic cases picked up incidentally,17 surgery for accessible and radiotherapy for inaccessible sites. Complete and safe resection is often not possible because of the tendency for radiation-induced meningiomas to be multiple, invasive and atypical or malignant.11,16 In addition, surgical healing can be compromised when prior radiotherapy has left a relatively avascular scalp.16 "
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    ABSTRACT: Childhood cancer is rare but improvements in treatment over the past five decades have resulted in a cohort of more than 30,000 long-term survivors of childhood cancer in the UK with more added annually. These long-term survivors are at risk of late effects of cancer treatment which replace original tumour recurrence as the leading cause of premature death. Second neoplasms are a particular risk and in the central nervous system meningiomas occur increasingly with increased radiation dose to central nervous system tissue and length of time after exposure, resulting in a 500-fold increase above that expected in the normal population by 40 years of follow up. This multidisciplinary author group and others met to discuss the issue. Our pooled information, and consensus that screening should only follow symptoms, was published online by the Royal College of Radiologists in 2013. We outline here the current knowledge and management of these neoplasms secondary to childhood cancer treatment.
    04/2014; 5(4):2054270414524567. DOI:10.1177/2054270414524567
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