Anaplastic oligoastrocytoma: previous treatment as a possible cause in a child with acute lymphoblastic leukemia

The authors present a 14-year-old patient who developed an anaplastic oligoastrocytoma of the left parietal lobe 9 years after a successful treatment of acute lymphoblastic leukemia (ALL). He had a history of induction chemotherapy, intrathecal methotrexate and prophylactic whole brain irradiation (1,800 cGy in 10 fractions over 2 weeks).

Radiation-induced neoplasia is suggested to be the late complication of ALL treatment, and evaluation of large clinical series revealed a relationship between young age at ALL diagnosis (<6 years) and increased high-grade glioma occurrence risk.

The authors have reviewed previously reported cases of secondary central nervous system malignancies focusing on age at ALL diagnosis, and they think that synergistic action of therapeutic modalities could have played a role in the oncogenetic process. Detailed systematic radiological follow-up should be done in these patients especially if a personal history of cranial irradiation is present.