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Higher doses of radiation, methotrexate increased risk for second primary tumors of CNS
Taylor AJ. J Clin Oncol. 2010;doi:10.1200/JCO.2009.27.0090.
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The risk for meningioma increased rapidly with increased dose of radiation to the meningeal tissue and with increased dose of intrathecal methotrexate in survivors of childhood cancer, according to researchers of the British Childhood Cancer Survivor Study.
“A serious consequence of treatment for childhood cancer is the development of second primary neoplasms,” the researchers wrote. “It is of particular interest to evaluate risks of brain tumor among individuals exposed during childhood because the risk appears to be higher for that population than for those individuals exposed during adulthood.”
The British Childhood Cancer Survivor Study cohort was linked to the National Health Service Central Register, and researchers used this link to identify 247 survivors of childhood cancer who developed a second primary neoplasm of the central nervous system (CNS), consisting of 137 meningiomas, 73 gliomas and 37 other CNS neoplasms.
The risk for meningioma increased significantly as the dose of radiation therapy to the meningeal tissue increased. For those who received 0.01 Gy to 9.99 Gy of radiation, the risk was twofold; for 10 Gy to 19.99 Gy of radiation, the risk was eightfold; for 20 Gy to 29.99 Gy of radiation, the risk was 52-fold; for 30 Gy to 39.99 Gy of radiation, the risk was 568-fold; and for at least 40 Gy of radiation, the risk was 479-fold.
Among those who received intrathecal methotrexate, the risk for meningioma also increased significantly as the dose of methotrexate increased. In those who received 1 mg/m2 to 39 mg/m2, the risk for meningioma was 15-fold; for those who received 40 mg/m2 to 69 mg/m2, the risk was 11-fold; and for those who received at least 70 mg/m2, the risk was 36-fold.
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