Morbidity and mortality associated with meningioma after cranial radiotherapy: A report from the childhood cancer survivor study

Daniel C. Bowers, Chaya S. Moskowitz, Joanne F. Chou, Claire M. Mazewski, Joseph P. Neglia, Gregory T. Armstrong, Wendy M. Leisenring, Leslie L. Robison, Kevin C. Oeffinger

Research output: Contribution to journalArticle

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Abstract

Purpose: Little is known about neurologic morbidity attributable to cranial radiotherapy (CRT) -associated meningiomas. Materials and Methods: From 4,221 survivors exposed to CRT in the Childhood Cancer Survivor Study, a diagnosis of meningioma and onset of neurologic sequelae were ascertained. Cox proportional hazards regression was used to estimate hazard ratios (HR) and 95% CIs to evaluate the factors associated with neurologic sequelae after subsequent meningioma. Results: One hundred ninety-nine meningiomas were identified among 169 participants. The median interval from primary cancer to meningioma diagnosis was 22 years (5 to 37 years). The cumulative incidence of a subsequent meningioma by age 40 years was 5.6% (95% CI, 4.7% to 6.7%). CRT doses of 20 to 29.9 Gy (HR, 1.6; 95% CI,1.0 to 2.6) and doses ≥ 30 Gy (HR, 2.6; 95% CI, 1.6 to 4.2) were associated with an increased risk of meningioma compared with CRT doses of 1.5 to 19.9 Gy (P < .001). Within 6 months before or subsequent to a meningioma diagnosis, 20% (30 of 149) reported at least one new neurologic sequela, including seizures (8.3%), auditory-vestibular-visual deficits (6%), focal neurologic dysfunction (7.1%), and severe headaches (5.3%). Survivors reporting a meningioma had increased risks of neurologic sequelae > 5 years after primary cancer diagnosis, including seizures (HR, 10.0; 95% CI, 7.0 to 15.3); auditory-vestibular-visual sensory deficits (HR, 2.3; 95% CI, 1.3 to 4.0); focal neurologic dysfunction (HR, 4.9; 95% CI, 3.2 to 7.5); and severe headaches (HR, 3.2; 95% CI, 1.9 to 5.4). With a median follow-up of 72 months after meningioma diagnosis (range, 3.8 to 395 months), 22 participants (13%) were deceased, including six deaths attributed to a meningioma. Conclusion: Childhood cancer survivors exposed to CRT and subsequently diagnosed with a meningioma experience significant neurologic morbidity.

Original languageEnglish (US)
Pages (from-to)1570-1576
Number of pages7
JournalJournal of Clinical Oncology
Volume35
Issue number14
DOIs
StatePublished - May 10 2017

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Meningioma
Survivors
Radiotherapy
Morbidity
Mortality
Neoplasms
Nervous System
Neurologic Manifestations
Headache
Seizures
Incidence

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

Cite this

Morbidity and mortality associated with meningioma after cranial radiotherapy : A report from the childhood cancer survivor study. / Bowers, Daniel C.; Moskowitz, Chaya S.; Chou, Joanne F.; Mazewski, Claire M.; Neglia, Joseph P.; Armstrong, Gregory T.; Leisenring, Wendy M.; Robison, Leslie L.; Oeffinger, Kevin C.

In: Journal of Clinical Oncology, Vol. 35, No. 14, 10.05.2017, p. 1570-1576.

Research output: Contribution to journalArticle

Bowers, DC, Moskowitz, CS, Chou, JF, Mazewski, CM, Neglia, JP, Armstrong, GT, Leisenring, WM, Robison, LL & Oeffinger, KC 2017, 'Morbidity and mortality associated with meningioma after cranial radiotherapy: A report from the childhood cancer survivor study', Journal of Clinical Oncology, vol. 35, no. 14, pp. 1570-1576. https://doi.org/10.1200/JCO.2016.70.1896
Bowers, Daniel C. ; Moskowitz, Chaya S. ; Chou, Joanne F. ; Mazewski, Claire M. ; Neglia, Joseph P. ; Armstrong, Gregory T. ; Leisenring, Wendy M. ; Robison, Leslie L. ; Oeffinger, Kevin C. / Morbidity and mortality associated with meningioma after cranial radiotherapy : A report from the childhood cancer survivor study. In: Journal of Clinical Oncology. 2017 ; Vol. 35, No. 14. pp. 1570-1576.
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abstract = "Purpose: Little is known about neurologic morbidity attributable to cranial radiotherapy (CRT) -associated meningiomas. Materials and Methods: From 4,221 survivors exposed to CRT in the Childhood Cancer Survivor Study, a diagnosis of meningioma and onset of neurologic sequelae were ascertained. Cox proportional hazards regression was used to estimate hazard ratios (HR) and 95{\%} CIs to evaluate the factors associated with neurologic sequelae after subsequent meningioma. Results: One hundred ninety-nine meningiomas were identified among 169 participants. The median interval from primary cancer to meningioma diagnosis was 22 years (5 to 37 years). The cumulative incidence of a subsequent meningioma by age 40 years was 5.6{\%} (95{\%} CI, 4.7{\%} to 6.7{\%}). CRT doses of 20 to 29.9 Gy (HR, 1.6; 95{\%} CI,1.0 to 2.6) and doses ≥ 30 Gy (HR, 2.6; 95{\%} CI, 1.6 to 4.2) were associated with an increased risk of meningioma compared with CRT doses of 1.5 to 19.9 Gy (P < .001). Within 6 months before or subsequent to a meningioma diagnosis, 20{\%} (30 of 149) reported at least one new neurologic sequela, including seizures (8.3{\%}), auditory-vestibular-visual deficits (6{\%}), focal neurologic dysfunction (7.1{\%}), and severe headaches (5.3{\%}). Survivors reporting a meningioma had increased risks of neurologic sequelae > 5 years after primary cancer diagnosis, including seizures (HR, 10.0; 95{\%} CI, 7.0 to 15.3); auditory-vestibular-visual sensory deficits (HR, 2.3; 95{\%} CI, 1.3 to 4.0); focal neurologic dysfunction (HR, 4.9; 95{\%} CI, 3.2 to 7.5); and severe headaches (HR, 3.2; 95{\%} CI, 1.9 to 5.4). With a median follow-up of 72 months after meningioma diagnosis (range, 3.8 to 395 months), 22 participants (13{\%}) were deceased, including six deaths attributed to a meningioma. Conclusion: Childhood cancer survivors exposed to CRT and subsequently diagnosed with a meningioma experience significant neurologic morbidity.",
author = "Bowers, {Daniel C.} and Moskowitz, {Chaya S.} and Chou, {Joanne F.} and Mazewski, {Claire M.} and Neglia, {Joseph P.} and Armstrong, {Gregory T.} and Leisenring, {Wendy M.} and Robison, {Leslie L.} and Oeffinger, {Kevin C.}",
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T1 - Morbidity and mortality associated with meningioma after cranial radiotherapy

T2 - A report from the childhood cancer survivor study

AU - Bowers, Daniel C.

AU - Moskowitz, Chaya S.

AU - Chou, Joanne F.

AU - Mazewski, Claire M.

AU - Neglia, Joseph P.

AU - Armstrong, Gregory T.

AU - Leisenring, Wendy M.

AU - Robison, Leslie L.

AU - Oeffinger, Kevin C.

PY - 2017/5/10

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N2 - Purpose: Little is known about neurologic morbidity attributable to cranial radiotherapy (CRT) -associated meningiomas. Materials and Methods: From 4,221 survivors exposed to CRT in the Childhood Cancer Survivor Study, a diagnosis of meningioma and onset of neurologic sequelae were ascertained. Cox proportional hazards regression was used to estimate hazard ratios (HR) and 95% CIs to evaluate the factors associated with neurologic sequelae after subsequent meningioma. Results: One hundred ninety-nine meningiomas were identified among 169 participants. The median interval from primary cancer to meningioma diagnosis was 22 years (5 to 37 years). The cumulative incidence of a subsequent meningioma by age 40 years was 5.6% (95% CI, 4.7% to 6.7%). CRT doses of 20 to 29.9 Gy (HR, 1.6; 95% CI,1.0 to 2.6) and doses ≥ 30 Gy (HR, 2.6; 95% CI, 1.6 to 4.2) were associated with an increased risk of meningioma compared with CRT doses of 1.5 to 19.9 Gy (P < .001). Within 6 months before or subsequent to a meningioma diagnosis, 20% (30 of 149) reported at least one new neurologic sequela, including seizures (8.3%), auditory-vestibular-visual deficits (6%), focal neurologic dysfunction (7.1%), and severe headaches (5.3%). Survivors reporting a meningioma had increased risks of neurologic sequelae > 5 years after primary cancer diagnosis, including seizures (HR, 10.0; 95% CI, 7.0 to 15.3); auditory-vestibular-visual sensory deficits (HR, 2.3; 95% CI, 1.3 to 4.0); focal neurologic dysfunction (HR, 4.9; 95% CI, 3.2 to 7.5); and severe headaches (HR, 3.2; 95% CI, 1.9 to 5.4). With a median follow-up of 72 months after meningioma diagnosis (range, 3.8 to 395 months), 22 participants (13%) were deceased, including six deaths attributed to a meningioma. Conclusion: Childhood cancer survivors exposed to CRT and subsequently diagnosed with a meningioma experience significant neurologic morbidity.

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