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Author Notes:

Corresponding author: Daniel C. Bowers, MD, Department of Pediatrics, UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-9063; e-mail: daniel.bowers@utsouthwestern.edu

Conception and design: Daniel C. Bowers, Chaya S. Moskowitz, Joanne F. Chou, Leslie L. Robison, Kevin C. Oeffinger

Provision of study materials or patients: Joseph P. Neglia

Collection and assembly of data: Daniel C. Bowers, Chaya S. Moskowitz, Joanne F. Chou, Wendy M. Leisenring, Kevin C. Oeffinger

Data analysis and interpretation: All authors

Manuscript writing: All authors

Final approval of manuscript: All authors

Accountable for all aspects of the work: All authors

The following represents disclosure information provided by authors of this manuscript. All relationships are considered compensated. Relationships are self-held unless noted. I = Immediate Family Member, Inst = My Institution. Relationships may not relate to the subject matter of this manuscript. For more information about ASCO's conflict of interest policy, please refer to www.asco.org/rwc or ascopubs.org/jco/site/ifc.

Daniel C. Bowers No relationship to disclose

Chaya S. Moskowitz Consulting or Advisory Role: BioClinica

Joanne F. Chou No relationship to disclose

Claire M. Mazewski No relationship to disclose

Joseph P. Neglia No relationship to disclose

Gregory T. Armstrong No relationship to disclose

Wendy M. Leisenring No relationship to disclose

Leslie L. Robison No relationship to disclose

Kevin C. Oeffinger No relationship to disclose


Research Funding:

Supported by Grants No. CA55727 and No. CA21765 (Cancer Center Support Grant) from the National Cancer Institute, and by the American Lebanese-Syrian Associated Charities.

Additional support by Grant No. CA008748 from the National Cancer Institute.


  • Science & Technology
  • Life Sciences & Biomedicine
  • Oncology

Morbidity and Mortality Associated With Meningioma After Cranial Radiotherapy: A Report From the Childhood Cancer Survivor Study


Journal Title:

Journal of Clinical Oncology


Volume 35, Number 14


, Pages 1570-1576

Type of Work:

Article | Final Publisher PDF


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.

Copyright information:

© 2017 by American Society of Clinical Oncology.

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