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방사선종양학
- 2017년 06월호
[J Clin Oncol.] Morbidity and Mortality Associated With Meningioma After Cranial Radiotherapy: A Report From the Childhood Cancer Survivor Study.UT Southwestern Medical Center / Daniel C. Bowers*
- 출처
- J Clin Oncol.
- 등재일
- 2017 May 10
- 저널이슈번호
- 35(14):1570-1576. doi: 10.1200/JCO.2016.70.1896. Epub 2017 Mar 24.
- 내용
Abstract
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.
Author information
Bowers DC1, Moskowitz CS1, Chou JF1, Mazewski CM1, Neglia JP1, Armstrong GT1, Leisenring WM1, Robison LL1, Oeffinger KC1.
1Daniel 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.
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