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Development of cystic malacia after high-dose cranial irradiation of pediatric CNS tumors in long-term follow-up

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Abstract

Purpose

The purpose of this study is to investigate the incidence of cystic malacia in long-term survivors of pediatric brain tumors treated with high-dose cranial irradiation.

Materials and methods

Between 1997 and 2015, we treated 41 pediatric patients (26 males, 15 females; age ranging from 3.3 to 15.7 years, median 9-year-old) of pediatric brain tumors [17 medulloblastomas, 7 primitive neuroectodermal tumors (PNET), 3 pineoblastomas, 6 non-germinomatous germ cell tumors (NGGCT), 8 gliomas (including 4 ependymomas, 1 anaplastic astrocytoma, 1 oligodendroglioma, 1 pilocytic astrocytoma, 1 astroblastoma)] with high-dose craniospinal irradiation. Follow-up ranged from 14.0 to 189.2 months (median 86.0 months, mean 81.5 months), the irradiation dose to the whole neural axis ranged from 18 to 41.4 Gy, and the total local dose from 43.2 to 60.4 Gy. All patients underwent follow-up magnetic resonance imaging (MRI) studies at least once a year. Diagnosis of cystic malacia was based solely on MRI findings. Of the 41 patients, 31 were censored during their follow-up due to recurrence of the primary disease (n = 5), detection of secondary leukemia after development of cystic malacia (n = 1), or the absence of cystic malacia on the last follow-up MRI study (n = 25). We also evaluated the development of post-irradiation cavernous angioma and white matter changes.

Results

Following irradiation treatment, 11 patients developed 19 cystic malacia during a median course of 30.8 months (range 14.9 to 59.3 months). The site of predilection for cystic malacia was white matter around trigone of lateral ventricles with an incidence of 47.4% (9 of 19 lesions, 7 in 11 patients). Patients with supratentorial tumors developed cystic malacia statistically earlier than the patients with infratentorial tumors (P = 0.0178, log-rank test). Among the same patient group, incidence of post-irradiation cavernous angioma increased progressively, while the incidence of post-irradiation cystic malacia did not increase after 5 years. White matter degeneration developed earlier than cystic malacia or cavernous angioma, and these three clinical entities developed mutually exclusive of each other.

Conclusion

We attribute the higher incidence of post-irradiation cystic malacia, in our long-term follow-up study, to the cranial irradiation for pediatric brain tumors, particularly supratentorial brain tumors, and recommend a regular, long-term follow-up of brain tumor patients treated with cranial irradiation.

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Acknowledgement

This study was partially supported by Japan Society for the promotion of Science Grant-in-Aid for Scientific Research (C) (Grant-in-aid nos. 16K10757) and financial support for research project related to childhood cancer by Children’s Cancer Association of Japan.

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Authors and Affiliations

  1. Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan

    Fumiyuki Yamasaki, Takeshi Takayasu, Ryo Nosaka, Ikuno Nishibuchi, Manish Kolakshyapati, Shumpei Onishi, Taiichi Saito & Kaoru Kurisu

  2. Department of Radiation Oncology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, 734-8551, Japan

    Ikuno Nishibuchi

  3. Department of Pediatrics, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, 734-8551, Japan

    Hiroshi Kawaguchi & Masao Kobayashi

  4. Department of Clinical Oncology & Neuro-oncology Program, Hiroshima University Hospital, Hiroshima, 734-8551, Japan

    Kazuhiko Sugiyama

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  1. Fumiyuki Yamasaki
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Corresponding author

Correspondence to Fumiyuki Yamasaki.

Ethics declarations

This retrospective study was approved by our institutional review board (No. E-454) and waived the need of written patient consent.

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All authors, none.

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Yamasaki, F., Takayasu, T., Nosaka, R. et al. Development of cystic malacia after high-dose cranial irradiation of pediatric CNS tumors in long-term follow-up. Childs Nerv Syst 33, 957–964 (2017). https://doi.org/10.1007/s00381-017-3400-7

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  • DOI: https://doi.org/10.1007/s00381-017-3400-7

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