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Incidental detection of late subsequent intracranial neoplasms with magnetic resonance imaging among adult survivors of childhood cancer

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Abstract

Purpose

Survivors of childhood cancer are at an increased risk of developing subsequent neoplasms. In long-term survivors of childhood malignancies treated with and without cranial radiation therapy (CRT), undergoing unenhanced magnetic resonance imaging (MRI) of the brain, we estimated detection of intracranial neoplasms.

Methods

To investigate neurocognitive outcomes, 219 survivors of childhood cancer underwent unenhanced screening MRI of the brain. Of the survivors, 164 had been treated for acute lymphoblastic leukemia (ALL) (125 received CRT) and 55 for Hodgkin lymphoma (HL) (none received CRT). MRI examinations were reviewed and systematically coded by a single neuroradiologist. Demographic and treatment characteristics were compared for survivors with and without subsequent neoplasms.

Results

Nineteen of the 219 survivors (8.7 %) had a total of 31 subsequent intracranial neoplasms identified by neuroimaging at a median time of 25 years (range 12–46 years) from diagnosis. All neoplasms occurred after CRT, except for a single vestibular schwannoma within the cervical radiation field in a HL survivor. The prevalence of subsequent neoplasms after CRT exposure was 14.4 % (18 of 125). By noncontrast MRI, intracranial neoplasms were most suggestive of meningiomas. Most patients presented with no specific, localizing neurological complaints. In addition to the schwannoma, six tumors were resected based on results of MRI screening, all of which were meningiomas on histologic review.

Conclusion

Unenhanced brain MRI of long-term survivors of childhood cancer detected a substantial number of intracranial neoplasms. Screening for early detection of intracranial neoplasms among aging survivors of childhood cancer who received CRT should be evaluated.

Implications for Cancer Survivors

The high prevalence of incidentally detected subsequent intracranial neoplasms after CRT in long-term survivors of childhood cancer and the minimal symptoms reported by those with intracranial tumors in our study indicate that brain MRI screening of long-term survivors who received CRT may be warranted. Prospective studies of such screening are needed.

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Conflict of interest

The authors have no conflict of interest to disclose.

Funding

This work was supported by the National Cancer Institute at the National Institutes of Health (grant number R21 CA138988, G.T. Armstrong, Principal Investigator). Support to St. Jude Children’s Research Hospital is also provided by the Cancer Center Support (CORE) grant (number CA 21765, R. Gilbertson, Principal Investigator) and the American Lebanese Syrian Associated Charities (ALSAC).

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Authors and Affiliations

  1. Department of Radiological Sciences, St. Jude Children’s Research Hospital, 262 Danny Thomas Place, Memphis, TN, 38105, USA

    Noah D. Sabin, Larry E. Kun, Matthew J. Krasin, Zoltan Patay, Wilburn E. Reddick, Robert J. Ogg & Claudia M. Hillenbrand

  2. Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, 262 Danny Thomas Place, Memphis, TN, 38105, USA

    Aimee K. Santucci, Leslie L. Robison, Kevin R. Krull & Gregory T. Armstrong

  3. Department of Oncology, St. Jude Children’s Research Hospital, 262 Danny Thomas Place, Memphis, TN, 38105, USA

    Melissa M. Hudson & Ching-Hon Pui

  4. Department of Biostatistics, St. Jude Children’s Research Hospital, 262 Danny Thomas Place, Memphis, TN, 38105, USA

    Deokumar Srivastava & Nan Zhang

  5. Semmes-Murphey Neurologic and Spine Institute, 6325 Humphreys Boulevard, Memphis, TN, 38120, USA

    Paul Klimo Jr.

  6. Department of Neurosurgery, University of Tennessee Health Science Center, 847 Monroe Avenue, Memphis, TN, 38163, USA

    Paul Klimo Jr.

Authors
  1. Noah D. Sabin
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  2. Aimee K. Santucci
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  4. Melissa M. Hudson
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  6. Nan Zhang
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  7. Larry E. Kun
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  8. Matthew J. Krasin
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  9. Ching-Hon Pui
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  10. Zoltan Patay
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  11. Wilburn E. Reddick
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  12. Robert J. Ogg
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  13. Claudia M. Hillenbrand
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  14. Leslie L. Robison
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  15. Kevin R. Krull
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  16. Gregory T. Armstrong
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Corresponding author

Correspondence to Noah D. Sabin.

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Supplemental Table 1

Characteristics of childhood cancer survivors who developed subsequent intracranial neoplasms (DOC 59 kb)

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Sabin, N.D., Santucci, A.K., Klimo, P. et al. Incidental detection of late subsequent intracranial neoplasms with magnetic resonance imaging among adult survivors of childhood cancer. J Cancer Surviv 8, 329–335 (2014). https://doi.org/10.1007/s11764-014-0344-8

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  • DOI: https://doi.org/10.1007/s11764-014-0344-8

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