Irradiation For Acute Lymphoblastic Leukemia Research Articles

Radiation-induced meningiomas (RIM) in adults: A single-centre retrospective experience

IntroductionRadiotherapy of central nervous system (CNS) is treatment against many paediatric cancers, even if it is a well-recognized risk factor for meningioma formation. An increased risk of developing secondary brain tumors like radiation-induced meningiomas (RIM) is related to irradiated patients. Research questionThis retrospective study aims to present RIM cases treated in a single tertiary-hospital in Greece and compare the results with international literature and cases of sporadic meningiomas. Materials and methodsA single-centre retrospective study of all patients diagnosed between January 2012 and September 2022 with RIM after having been irradiated in CNS for paediatric cancer was undertaken through hospital’s electronic record and clinical notes, identifying baseline demographics and latency period. ResultsThirteen patients were identified with RIM diagnosis after receiving irradiation for Acute Lymphoblastic Leukaemia (69.2%), Premature Neuro-Ectodermal Tumour (23.1%), and Astrocytoma (7.7%). Median age at irradiation was 5 years old and 32 years old at RIM’s presentation. The latent period from irradiation to meningioma diagnosis was 26.23 ​± ​5.96 years. After surgical excision, histopathologic results showed grade I meningiomas in 12 out of thirteen cases, while only one atypical meningioma was diagnosed. ConclusionPatients who underwent CNS-radiotherapy in childhood for any condition have an increased risk of developing secondary brain tumors such as radiation-induced meningiomas. RIMs resemble sporadic meningiomas in symptomatology, location, treatment, and histologic grade. However, long-term follow-up and regular check-ups are recommended in irradiated patients due to short latency period from irradiation to RIM development, which means younger age patients than those with sporadic meningiomas cases.

First person profile: Ching-Hon Pui, MD: An internationally renowned pediatric oncologist, Dr. Pui helped to push the cure rate for pediatric acute lymphoblastic leukemia to more than 90.

First person profile: Ching-Hon Pui, MD: An internationally renowned pediatric oncologist, Dr. Pui helped to push the cure rate for pediatric acute lymphoblastic leukemia to more than 90.

Stroke-like Migraine Attacks after Radiation Therapy (SMART) Syndrome Followed by Cerebral Infarction

A 36-year-old man with a history of irradiation for acute lymphoblastic leukemia developed headache with cortical dysfunction lasting for 4 weeks. The clinical features were consistent with stroke-like migraine attacks after radiation therapy (SMART) syndrome. Six months later, he developed cerebral infarction due to occlusions of the left anterior and middle cerebral arteries. This is the first case report describing SMART syndrome followed by severe cerebral infarction. Although an association between the two episodes was not assumed, this case indicates that protective therapies against infarction might need to be considered for patients with SMART syndrome.

Pulmonary toxicity following total body irradiation for acute lymphoblastic leukaemia: The Ottawa Hospital Cancer Centre (TOHCC) experience

AbstractPurposeTo review the incidence of clinically significant pulmonary toxicity following total body irradiation (TBI) as a part of the conditioning regimen for acute lymphoblastic leukaemia (ALL) patients undergoing bone marrow transplantation (BMT) at The Ottawa Hospital Cancer Centre.MethodsThis is a retrospective review of ALL patients who received TBI in The Ottawa Hospital Bone Marrow Transplant Program (TOH-BMT) as part of their conditioning regimen from 1991 to 2011 inclusive. The patients were treated using a locally developed translating-couch irradiation technique. We have analysed all available data for the first 100 days following TBI to determine the incidence of radiation-induced pulmonary toxicities.ResultsOf the total 622 patients undergoing TBI during the specified period, 88 had ALL. Median age at BMT was 30 years and the conditioning regimens varied. A total of 74 (84%) patients received 12 Gy/6 F/BID of TBI. A total of 55 (63%) patients have died, 32 (36%) within the 1st year after BMT. In the 1st year, pulmonary events were reported for 24 (27%) patients, and the follow-up notes were unavailable for seven (8%). Pulmonary toxicities were reported as the cause of death for six patients, five (6%) within the 1st year. It is estimated that the total number of deaths in the 1st year possibly attributed to radiation-induced lung injury was four (4·5%). Eight (9%) patients had symptoms suggestive of non-lethal grade 2–3 radiation-induced pneumonitis.ConclusionsTBI continues to be an important component of the conditioning regimen for ALL patients undergoing BMT, and the incidence of radiation-induced pulmonary injury, using our technique and lung dose, is comparable to the published literature.

Pulmonary Toxicity Following Total Body Irradiation for Acute Lymphoblastic Leukemia: The Ottawa Hospital Cancer Centre (TOHCC) Experience

Pulmonary Toxicity Following Total Body Irradiation for Acute Lymphoblastic Leukemia: The Ottawa Hospital Cancer Centre (TOHCC) Experience

Psychosocial life achievements in adults even if they received prophylactic cranial irradiation for acute lymphoblastic leukemia during childhood

The aim of this study was to assess life goal achievements in long-term survivors (LTS) receiving cranial radiotherapy (CRT) as central nervous system (CNS) prophylaxis for acute lymphoblastic leukemia (ALL) during childhood, compared to healthy individuals. Participants in this study were 141 LTS treated in our center from 1961 to 1990. Questionnaires were mailed to LTS. Analyses were stratified by age classes comparing LTS and a matched healthy population living in the same geographic area, as well as comparing patients treated with 24 Gy vs. 18 Gy CRT. Survivors reached the same educational level as controls. Significant differences were noted according to age and CRT dose. LTS had similar employment rates to those of controls, but lower marriage rates. Most respondents described their life positively, but as worse in the 24 Gy group. This study highlights the good life satisfaction of our LTS despite the long-term effects of the disease and its treatment.

Atypical teratoid rhabdoid tumor located in the pineal region following prophylactic irradiation for acute lymphoblastic leukemia

Atypical teratoid rhabdoid tumor (AT/RT) is a rare entity. In the central nervous system, AT/RT generally arises from the posterior fossa of infants and behaves aggressively. AT/RT is reported to arise from the infratentorial region (63%) and other sites, such as the suprasellar region, cerebellopontine angle, and spinal cord. The pineal region is rare (6%) as a site of origin. Radiation-induced brain tumors are well known. In this report, we present a case of a pineal region tumor causing acute hydrocephalus that could be pathologically diagnosed as AT/RT following prophylactic cranial irradiation for acute lymphoblastic leukemia.

急性リンパ性白血病に対する放射線治療後に発生した髄膜腫の1例

放射線誘発性髄膜腫についてはよく知られているが, 以前の開頭部位に一致して髄膜腫が発生したという報告は少ない. 今回われわれは頭部の放射線治療の9年後に脳動静脈奇形切除術を施行され, 開頭部位に一致して髄膜腫が発生した1例を経験した. 患者は2歳時に急性リンパ性白血病の診断で, 化学療法と放射線頭蓋照射を受けた. 11歳時には左頭頂部の動静脈奇形を切除され, このときに人工硬膜を使用されている. 22歳時には, 以前の開頭手術と同一部位に発生した髄膜腫を発見され, 摘出術を受けた. 放射線照射に加え, surgical traumaや慢性炎症反応も腫瘍形成に関与したために, 以前の開頭手術と同一部位に髄膜腫が発生しやすい環境になったものと推測された.

Radiation-Induced World Health Organization Grade II Meningiomas in Young Patients Following Prophylactic Cranial Irradiation for Acute Lymphoblastic Leukemia in Childhood

Current chemotherapeutic regimens have been used to successfully treat many children with acute lymphoblastic leukemia (ALL), but have resulted in an increased risk of late central nervous system tumors, most commonly meningioma, particularly in patients who have received cranial irradiation. We treated 3 young patients with World Health Organization grade II meningiomas who had previously received cranial irradiation for the treatment of childhood ALL: a cerebellopontine angle tumor in a 19-year-old woman, a petroclival tumor in a 28-year-old man, and a frontal parasagittal tumor in a 19-year-old woman. These cases were difficult to treat due to the aggressive and invasive biology of the tumors. Therefore, we recommend systematic cranial imaging and long follow-up periods for leukemia survivors to detect brain tumors before progression.

Growth Retardation and Bilateral Cataracts Followed by Anaplastic Meningioma 23 Years after High-Dose Cranial and Whole-Body Irradiation for Acute Lymphoblastic Leukemia: Case Report and Review of the Literature

We report a case of meningioma diagnosed 23 years after high-dose cranial and whole-body irradiation for the treatment of acute lymphocytic leukemia (ALL). Radiotherapy in this case also caused early radiation injury to the lenses and the pituitary gland, with growth retardation and mineralizing angiopathy. Radiation-induced meningiomas are more commonly malignant, more commonly multiple, and more likely to recur after resection than non-radiation-induced meningiomas. Survivors of childhood ALL treated with high-dose cranial irradiation are at risk both for early radiation injury in radiosensitive organs, such as the lens and pituitary gland, and for the later development of a radiation-induced meningioma.

Second thyroid neoplasms after prophylactic cranial irradiation for acute lymphoblastic leukemia

Second thyroid neoplasms after prophylactic cranial irradiation for acute lymphoblastic leukemia

Oral squamous cell carcinoma following treatment of acute lymphoblastic leukaemia

With substantially increased survival after most paediatric cancers over the past decades have come the late sequelae of treatment. Of all late complications of treatment, second malignancies are generally considered to be the most serious. We report on a 20-year-old man with an oral squamous cell carcinoma 17 years after initial chemotherapy and irradiation for acute lymphoblastic leukaemia. Although occurrence of the oral malignancy in this patient could have been treatment-related, one should keep in mind that the occurrence of second tumours may also be based on a shared genetic aetiology.

Craniospinal irradiation for acute lymphoblastic leukemia with central nervous system disease at diagnosis: A report from the children's cancer group

Purpose : This study attempted to determine if central nervous system (CNS) disease at diagnosis is a poor prognostic factor in children with acute lymphoblastic leukemia (ALL) and whether 6 Gy of spinal irradiation is an adequate dose for these patients. Methods and Materials : Previously the Children's Cancer Group (CCG) treated patients with ALL and CNS disease at diagnosis with cranio (24 Gy)-spinal (12 Gy) irradiation, as well as systemic and intrathecal chemotherapy. In a series of CCG trials completed in 1989 the spinal dose was empirically reduced to 6 Gy for patients receiving systemic chemotherapy with an intensive consolidation phase to limit hematopoietic toxicity. The spinal dose was left at 12 Gy for patients treated with a less intensive consolidation phase. Results : With a median follow-up for surviving patients of 74 months, the 5-year event-free survival for 53 patients with CNS disease at diagnosis was 69 ± 13% (±2 standard deviations), similar to the value obtained for 3364 patients without CNS disease, 67 ± 2%. Corresponding values for 5-year survival were 77 ± 12% and 80 ± 1%, and for freedom from isolated first CNS relapse, 90 ± 9% and 94 ± 1%. Event-free survival, survival, and freedom from isolated first CNS relapse in the 6-Gy group were as good as in the 12-Gy group. Conclusion : CNS disease at diagnosis is not a poor prognostic factor for children with ALL who are treated with intensive systemic chemotherapy, craniospinal irradiation, and intrathecal chemotherapy. Six Gy is an adequate dose of spinal irradiation for these patients.

Late aggressive meningioma following prophylactic cranial irradiation for acute lymphoblastic leukaemia

We read with interest the recent case report by Stein et al [1] describing the late development of an aggressive meningioma 20 years following cranial irradiation for acute lymphoblastic leukaemia (ALL). There are only a handful of case reports in the literature of meningioma developing between 5 and 23 years following cranial irradiation for ALL.

Late aggressive meningioma following prophylactic cranial irradiation for acute lymphoblastic leukaemia

There is an increasing number of reports concerning the induction of late brain tumours in survivors of childhood acute lymphoblastic leukaemia (ALL). The overwhelming majority of these patients received aggressive combined modality treatment, including systemic and intrathecal chemotherapy (methotrexate) and prophylactic cranial irradiation [1]. The late appearing tumours include mainly astrocytomas of various grades, glioblastoma muliforme and meningiomas. Most of these tumours exhibit malignant histological features (pleomorphism, high cellularity, atypical mitoses) and an aggressive behaviour (multiplicity and recurrence), necessitating repeated resections and even re-irradiation [1–3]. The aetiology of these induced brain tumours is not solely related to radiation therapy components (total dose, daily fractionation) but also to prolonged exposure to neurotoxic chemotherapeutic agents and, possibly, to inherent genetic susceptibility.

Secondary tumours after prophylactic cranial irradiation

A 22 year old woman, who at the age of 6 years had prophylactic cranial irradiation for acute lymphoblastic leukaemia, presented with both astrocytoma of the brain and breast carcinoma. The link between the two solid tumours and previous cranial irradiation is discussed.

Intracranial large vessel vasculopathy and anaplastic meningioma 19 years after cranial irradiation for acute lymphoblastic leukaemia

A child was diagnosed in 1969 as having acute lymphoblastic leukaemia (ALL) and received chemotherapy. On bone marrow relapse in 1973, he was treated with cranial irradiation (20 Gy) in addition to chemotherapy. He continues in complete remission 19 years after his relapse. At age 25 years, he presented with headaches and left hemiparesis. Computerised tomograph demonstrated a large, enhancing right-sided intracranial tumour. Angiography was performed and showed the right internal carotid artery was occluded. Most of the right hemisphere was supplied from the external carotid via the middle meningeal artery. The left posterior cerebral artery and the left anterior cerebral artery were absent presumably as a result of radiation-induced arteritis. A resection of an anaplastic meningioma arising from the right sphenoidal ridge was achieved. There was a rapid improvement in function and he returned to work. Vasculopathy of the large intracranial arteries has been described after high dose radiation. It may occur as in this case after moderate dose radiation. There is a correlation with meningioma. There is a possibility that large artery vasculopathy will be present in a proportion of patients irradiated for ALL. The long lag time between irradiation and the development of meningioma may mean that, as survivors of childhood ALL enter their third decade since cure, this tumour may be seen increasingly.

Late cranial MRI after cranial irradiation in survivors of childhood cancer

We carried out MRI on 43 survivors of childhood cancer after different treatment protocols with or without cranial radiotherapy. They were free of disease, therapy having been discontinued 2-20 years earlier. Treatment had been for various malignancies, excluding brain tumours; 27 had received cranial irradiation for acute lymphoblastic leukaemia (ALL) or lymphoma. Two asymptomatic young women treated for ALL had falx meningiomas. White matter changes, low intensity foci (representing calcification or old haemorrhage) and heterogeneous intensity focic old haemorrhages) were seen only in patients who had undergone radiotherapy. Because of the possibility of benign, potentially curable brain tumours occurring after cranial irradiation, it may be wise to carry out occasional cranial imaging in the follow-up of these patients. No routine imaging follow-up is needed after chemotherapy alone.

Radiation and Hypothalamic Pituitary Function

Deficiency of one or more anterior pituitary hormones may follow treatment with external radiation when the hypothalamic-pituitary axis falls within the fields of radiation. Hypopituitarism has been described in patients who received radiation therapy for nasopharyngeal carcinoma, tumors of the pituitary gland or nearby structures, and primary brain tumors, as well as in children who underwent prophylactic cranial irradiation for acute lymphoblastic leukemia or total body irradiation (TBI) for a variety of tumors and other diseases.There is strong evidence that the hypothalamus is the major site of radiation-induced damage and a growing belief that the pathological basis for the damage is direct neuronal injury rather than vascular-mediated.As radiation therapy and chemotherapy for patients with tumors of the brain and surrounding structure improve, follow-up evaluation will need to focus less on the possibility of tumor recurrence and more on the delayed effects of therapy, including the endocrine effects. Pituitary hormone deficiencies are common and may not develop for many years.

Gonadotropin Releasing Hormone Analogue and Growth Hormone Therapy in Precocious and Premature Puberty following Cranial Irradiation for Acute Lymphoblastic Leukaemia

Ten girls with early puberty secondary to cranial irradiation as a part of the treatment for acute lymphoblastic leukaemia (ALL) were treated with either gonadotropin-releasing hormone analogue (GnRHa) and human growth hormone (GH) (8 girls) or with GnRHa alone (2 girls). After 4 years of treatment, height SDS for bone age was improved in the group who received combined treatment (from -0.97 to +0.07, p < 0.001), in contrast to the 2 patients who received GnRHa alone in whom height standard deviation scores for bone age decreased (from -1.10 to -1.33). Sitting height in all patients was relatively shorter than leg length, and there was no significant alteration during the 4 years of treatment.