Meningioma as a late effect of cancer treatment

Contents Summary and recommendations 4 Radiation-induced meningiomas 4 Radiation-induced versus sporadic meningiomas 4 Those at risk 4 Latency 4 Care plans, long-term follow-up, lost to follow-up 4 Recommendations 4 Introduction 5 Incidence and aetiology of sporadic meningioma 6 Increasing incidence 6 Effect of age 6 Known aetiological associations 6 Exposure to ionising radiation 6 Hormones 6 Chemical exposure 6 Family history 6 Meningioma as second primary neoplasm (radiation-induced meningioma) 7 Radiation-induced meningioma 7 Radiation – definitions of dose level 7 Time to development and radiation dose 7 Groups at risk 7 Effect of low-dose radiation 7 Exposure to atomic bomb 7 Therapeutic radiation for tinea capitis 7 Dental radiographic examinations 7 Effect of high-dose radiation 8 Therapeutic radiation for childhood cancer 8 Latency period 8 Age 8 Chemotherapy 8 Effect of growth hormone 8 Genetics 8 Sex ratio 8 Location 8 Differences from spontaneous meningiomas 8 Diagnosis: imaging 9 Imaging features of secondary meningiomas 9 Clinical presentations 9 Imaging in symptomatic patients 9 Follow-up scans after treatment involving the brain in asymptomatic patients 9 Diagnosis: pathology 10 Primary (sporadic) meningiomas 10 Cytogenetic changes in spontaneous meningiomas 10 Histopathological classification of spontaneous meningiomas 10 Hormone receptor expression 11 Spontaneous meningiomas in childhood 11 Radiation-induced meningiomas 11 Cytogenetics of radiation-induced meningiomas 11 Histopathological classification of radiation-induced meningiomas 11 Management 12 The management of meningiomas – surgery 12 Surgical limitations in radiation-induced meningioma 12 Previously irradiated skin 12 The management of meningiomas – radiotherapy 12 Radiotherapy in sporadic meningioma 12 The dose of fractionated radiotherapy 13 Stereotactic radiotherapy or stereotactic surgery 13 Radiation-induced meningioma 13 Intensity-modulated radiation therapy 13 Protons 13 Adjuvant hormones or cytotoxics 13 Prognosis 14 Surveillance 15 Long-term follow-up 15 Screening for second neoplasm 15 Potential benefits of screening 15 Potential disadvantages of screening 15 Who should be scanned? 15 Pregnancy 15 Modality 16 Imaging interval 16 Recommendations 16 References 17 Appendix 1. Case studies 20 Membership of the Working Group 22 Abbreviations 23 4 Summary and recommendations Radiation-induced meningiomas New cranial neoplasms following exposure of the brain to radiation were first recorded over 40 years ago and of these neoplasms, meningiomas are the most common. The risk of meningiomas appears to be highest in those exposed in childhood and ascertainment of meningiomas in this group increases with both time since treatment and radiation dose. After 40 years of follow-up, the cumulative incidence of meningiomas in the exposed cohort is …