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Pooled Analysis of Meningioma Risk Following Treatment for Childhood Cancer
Diana R Withrow1, Harald Anderson2, Gregory T Armstrong3
1Nuffield Department of Primary Care Health Sciences, Medical Sciences Division, University of Oxford, Oxford, United Kingdom.
JAMA Oncology
|October 6, 2022
Summary
Childhood cancer survivors exposed to cranial radiation, especially before age 10, face a significantly increased risk of meningioma, a brain tumor. This risk persists for decades, underscoring the need to limit radiation exposure in pediatric cancer treatment.
Area of Science:
- Neuro-oncology
- Pediatric oncology
- Radiation oncology
Background:
- Meningioma is the most common secondary neoplasm after cranial irradiation in childhood cancer survivors.
- Uncertainties remain regarding radiation dose-response, risk modifiers, and chemotherapy's role in meningioma development.
Purpose of the Study:
- To assess meningioma risk in childhood cancer survivors treated with radiotherapy and chemotherapy.
- To identify factors that may modify radiation-associated meningioma risk.
Main Methods:
- An international case-control study pooled data from 4 nested case-control studies.
- Included survivors diagnosed between 1942-2000, followed through 2016.
- Analyzed radiation dose and chemotherapy exposure, including methotrexate.
Main Results:
- Increased radiation dose correlated with higher meningioma risk (EOR/Gy, 1.44).
- Doses ≥24 Gy resulted in >30-fold increased odds of meningioma.
- Risk was higher for those treated before age 10 and persisted for 30 years post-radiation. Methotrexate use also increased risk (OR, 3.43).
Conclusions:
- The meninges are highly radiosensitive, particularly in children under 10.
- Findings support reducing whole-brain irradiation and prioritizing radiation-sparing techniques in pediatric oncology.
- Elevated meningioma risk for 30 years post-radiotherapy may inform long-term surveillance strategies.
