[Radiosurgery and brain radio-induced carcinogenesis: update]

The use of radiosurgery Gamma-knife for many benign tumors and diseases has increased significantly over the last two decades. The long-term potential carcinogenic risk has not been evaluated until recently. The definition of radio-induced tumors was based on Cahan's criteria: it must occur in the previously irradiated field, with a sufficiently long interval from irradiation, it must be pathologically different from the primary tumor, not be present at time of irradiation and no genetic predisposition for second tumor. The brain is one of most sensitive tIssues and no minimal dose has been established. Even doses as low as 1 Gy have been associated with second tumor formation and relative risk between 1.57 and 8.75. This relative risk increases to 18.4 for an interval time between 20 and 25 Years. Many publications emphaze the risks after larger-field, fractionated radiotherapy with low non-cell-killing dose delivered to central nervous system. Furthermore, therapeutic radiation doses for benign tumors associated with a long life (parasellar tumors, meningioma) were implicated in carcinogenesis. Incidence of radiation-associated tumors is linked to different factors such as age and individual genetic susceptibility. At this time and to our knowledge, 3 radiation-associated gliomas and 5 malignant acoustic neurinomas have been reported in the literature. Moreover, these second tumors met some but not all Cahan criteria. We also report 2 cases from our radiosurgical experience and discuss these points. Long time follow-up is needed to observe the crude incidence of radiation-induced tumors at 5 to 30 Years. The relative risk is estimated less than 1 and must be announced to each patient before the radiosurgical procedure and counterbalanced wit the 1% annual risk of mortality from bleeding of untreated MAV or the 1% mortality rate of benign tumors after surgery alone.