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Journal of Radiation Oncology

Published in:

01-03-2013 | Case Report

Adult medulloblastoma following fractionated proton therapy for acoustic neuroma

Authors: Mark N. Jabbour, Fady B. Geara, Roula Hourani, Badih Adada, Jean G. Rebeiz, Mamdouha Ahdab-Barmada

Published in: Journal of Radiation Oncology | Issue 1/2013

Abstract

Introduction:

Radiation-induced medulloblastoma is exceedingly rare. Four cases of adult medulloblastoma were previously reported to have occurred following whole brain or craniospinal irradiation. Development of systemic malignancies secondary to proton beam therapy is extremely uncommon, with a lifetime risk lower than 1 %.

Methods and Results:

A 39-year-old woman presented with gait instability and a right cerebellar mass following an 8-year latency period post-fractionated proton therapy for an acoustic neuroma. To date, no cases of new onset medulloblastoma have been reported following proton beam therapy. The differential diagnosis by imaging studies includes brain radiation necrosis.

Conclusion:

The current report highlights the possible, although rare, risks and complications associated with proton beam radiation. Further studies are needed to address issues related to the management and treatment of radiation-induced medulloblastomas.

Brandes AA, Franceschi E, Tosoni A, Blatt V, Ermani M (2007) Long-term results of a prospective study on the treatment of medulloblastoma in adults. Cancer 110(9):2035–2041. doi:10.1002/cncr.23003 PubMedCrossRef

Sirachainan N, Nuchprayoon I, Thanarattanakorn P, Pakakasama S, Lusawat A, Visudibhan A, Dhanachai M, Larbcharoensub N, Amornfa J, Shotelersuk K, Katanyuwong K, Tangkaratt S, Hongeng S (2011) Outcome of medulloblastoma in children treated with reduced-dose radiation therapy plus adjuvant chemotherapy. J Clin Neurosci 18(4):515–519. doi:10.1016/j.jocn.2010.08.012 PubMedCrossRef

Smoll NR (2011) Relative survival of childhood and adult medulloblastomas and primitive neuroectodermal tumors (PNETs). Cancer 118(5):1313–1322. doi:10.1002/cncr.26387

Padma MV, Jacobs M, Kraus G, McDowell P, Satter M, Adineh M, Mantil J (2004) Radiation-induced medulloblastoma in an adult: a functional imaging study. Neurol India 52(1):91–93PubMed

Howes TL, Buatti JM, Kirby PA, Carlisle TL, Ryken TC (2006) Radiation induced adult medulloblastoma: a case report. J Neurooncol 80(2):191–194. doi:10.1007/s11060-006-9175-4 PubMedCrossRef

Chan MD, Attia A, Tatter SB, Lesser G, Zapadka ME, Mott RT, Carter A, McMullen KP, Shaw EG, Ellis TE (2011) Radiation-induced adult medulloblastoma: a two-case report and review of the literature. J Neurooncol 103(3):745–749. doi:10.1007/s11060-010-0426-z PubMedCrossRef

McIver JI, Pollock BE (2004) Radiation-induced tumor after stereotactic radiosurgery and whole brain radiotherapy: case report and literature review. J Neurooncol 66(3):301–305PubMedCrossRef

Niranjan A, Kondziolka D, Lunsford LD (2009) Neoplastic transformation after radiosurgery or radiotherapy: risk and realities. Otolaryngol Clin North Am 42(4):717–729. doi:10.1016/j.otc.2009.04.005 PubMedCrossRef

Shamisa A, Bance M, Nag S, Tator C, Wong S, Noren G, Guha A (2001) Glioblastoma multiforme occurring in a patient treated with gamma knife surgery. Case report and review of the literature. J Neurosurg 94(5):816–821. doi:10.3171/jns.2001.94.5.0816 PubMedCrossRef

10.

Zacharatou-Jarlskog C, Paganetti H (2008) Risk of developing second cancer from neutron dose in proton therapy as function of field characteristics, organ, and patient age. Int J Radiat Oncol Biol Phys 72(1):228–235. doi:10.1016/j.ijrobp.2008.04.069 PubMedCrossRef

11.

Shah SK, Lui PD, Baldwin DD, Ruckle HC (2006) Urothelial carcinoma after external beam radiation therapy for prostate cancer. J Urol 175(6):2063–2066. doi:10.1016/S0022-5347(06)00324-7 PubMedCrossRef

12.

Brenner DJ, Hall EJ (2008) Secondary neutrons in clinical proton radiotherapy: a charged issue. Radiother Oncol 86(2):165–170. doi:10.1016/j.radonc.2007.12.003 PubMedCrossRef

13.

Levin WP, Kooy H, Loeffler JS, DeLaney TF (2005) Proton beam therapy. Br J Cancer 93(8):849–854. doi:10.1038/sj.bjc.6602754 PubMedCrossRef

14.

Lee KB, Kim KR, Huh TL, Lee YM (2008) Proton induces apoptosis of hypoxic tumor cells by the p53-dependent and p38/JNK MAPK signaling pathways. Int J Oncol 33(6):1247–1256PubMed

15.

Oh BC, Pagnini PG, Wang MY, Liu CY, Kim PE, Yu C, Apuzzo ML (2007) Stereotactic radiosurgery: adjacent tissue injury and response after high-dose single fraction radiation: Part I—histology, imaging, and molecular events. Neurosurgery 60(1):31–44. doi:10.1227/01.NEU.0000249191.23162.D2, discussion 44–35PubMedCrossRef

16.

Kargiotis O, Geka A, Rao JS, Kyritsis AP (2010) Effects of irradiation on tumor cell survival, invasion and angiogenesis. J Neurooncol 100(3):323–338. doi:10.1007/s11060-010-0199-4 PubMedCrossRef

17.

Lin W, Lin Y, Li J, Harding HP, Ron D, Jamison S (2011) A deregulated integrated stress response promotes interferon-gamma-induced medulloblastoma. J Neurosci Res 89(10):1586–1595. doi:10.1002/jnr.22693 PubMedCrossRef

18.

Cahan WG, Woodard HQ et al (1948) Sarcoma arising in irradiated bone; report of 11 cases. Cancer 1(1):3–29PubMedCrossRef

19.

Baser ME, Evans DG, Jackler RK, Sujansky E, Rubenstein A (2000) Neurofibromatosis 2, radiosurgery and malignant nervous system tumours. Br J Cancer 82(4):998. doi:10.1054/bjoc.1999.1030 PubMedCrossRef

20.

Plowman PN, Evans DG (2000) Stereotactic radiosurgery XI. Acoustic neuroma therapy and radiation oncogenesis. Br J Neurosurg 14(2):93–95PubMedCrossRef

21.

Mathieu D, Kondziolka D, Flickinger JC, Niranjan A, Williamson R, Martin JJ, Lunsford LD (2007) Stereotactic radiosurgery for vestibular schwannomas in patients with neurofibromatosis type 2: an analysis of tumor control, complications, and hearing preservation rates. Neurosurgery 60(3):460–468. doi:10.1227/01.NEU.0000255340.26027.53, discussion 468–470PubMed

22.

Glass JP, Hwang TL, Leavens ME, Libshitz HI (1984) Cerebral radiation necrosis following treatment of extracranial malignancies. Cancer 54(9):1966–1972PubMedCrossRef

23.

Marks JE, Wong J (1985) The risk of cerebral radionecrosis in relation to dose, time and fractionation. A follow-up study. Prog Exp Tumor Res 29:210–218PubMed

24.

Hazle JD, Jackson EF, Schomer DF, Leeds NE (1997) Dynamic imaging of intracranial lesions using fast spin-echo imaging: differentiation of brain tumors and treatment effects. J Magn Reson Imaging 7(6):1084–1093PubMedCrossRef

25.

Fulham MJ, Bizzi A, Dietz MJ, Shih HH, Raman R, Sobering GS, Frank JA, Dwyer AJ, Alger JR, Di Chiro G (1992) Mapping of brain tumor metabolites with proton MR spectroscopic imaging: clinical relevance. Radiology 185(3):675–686PubMed

26.

Brodin NP, Munck af Rosenschold PM, Aznar MC, Kiil-Berthelsen AK, Vogelius IR, Nilsson P, Lannering B, Bjork-Eriksson T (2011) Radiobiological risk estimates of adverse events and secondary cancer for proton and photon radiation therapy of pediatric medulloblastoma. Acta Oncol 50(6):806–816. doi:10.3109/0284186X.2011.582514 PubMedCrossRef

27.

Miralbell R, Lomax A, Cella L, Schneider U (2002) Potential reduction of the incidence of radiation-induced second cancers by using proton beams in the treatment of pediatric tumors. Int J Radiat Oncol Biol Phys 54(3):824–829PubMedCrossRef

28.

Giordana MT, Schiffer P, Lanotte M, Girardi P, Chio A (1999) Epidemiology of adult medulloblastoma. Int J Cancer 80(5):689–692. doi:10.1002/(SICI)1097-0215 PubMedCrossRef

29.

Schuller U, Heine VM, Mao J, Kho AT, Dillon AK, Han YG, Huillard E, Sun T, Ligon AH, Qian Y, Ma Q, Alvarez-Buylla A, McMahon AP, Rowitch DH, Ligon KL (2008) Acquisition of granule neuron precursor identity is a critical determinant of progenitor cell competence to form Shh-induced medulloblastoma. Cancer Cell 14(2):123–134. doi:10.1016/j.ccr.2008.07.005 PubMedCrossRef

30.

Janss AJ, Yachnis AT, Silber JH, Trojanowski JQ, Lee VM, Sutton LN, Perilongo G, Rorke LB, Phillips PC (1996) Glial differentiation predicts poor clinical outcome in primitive neuroectodermal brain tumors. Ann Neurol 39(4):481–489. doi:10.1002/ana.410390410 PubMedCrossRef

31.

Goldberg-Stern H, Gadoth N, Stern S, Cohen IJ, Zaizov R, Sandbank U (1991) The prognostic significance of glial fibrillary acidic protein staining in medulloblastoma. Cancer 68(3):568–573PubMedCrossRef

32.

Coffin CM, Mukai K, Dehner LP (1983) Glial differentiation in medulloblastomas. Histogenetic insight, glial reaction, or invasion of brain? Am J Surg Pathol 7(6):555–565PubMedCrossRef

33.

Gessi M, von Bueren AO, Rutkowski S, Pietsch T (2012) p53 expression predicts dismal outcome for medulloblastoma patients with metastatic disease. J Neurooncol 106(1):135–141. doi:10.1007/s11060-011-0648-8 PubMedCrossRef

34.

Ertan Y, Sezak M, Demirag B, Kantar M, Cetingul N, Turhan T, Ersahin Y, Mutluer S, Anacak Y, Akalin T (2009) Medulloblastoma: clinicopathologic evaluation of 42 pediatric cases. Childs Nerv Syst 25(3):353–356. doi:10.1007/s00381-008-0784-4 PubMedCrossRef

35.

Dee S, Haas-Kogan DA, Israel MA (1995) Inactivation of p53 is associated with decreased levels of radiation-induced apoptosis in medulloblastoma cell lines. Cell Death Differ 2(4):267–275PubMed

36.

Hader WJ, Drovini-Zis K, Maguire JA (2003) Primitive neuroectodermal tumors in the central nervous system following cranial irradiation: a report of four cases. Cancer 97(4):1072–1076. doi:10.1002/cncr.11121 PubMedCrossRef

37.

Merchant TE, Boop FA, Kun LE, Sanford RA (2008) A retrospective study of surgery and reirradiation for recurrent ependymoma. Int J Radiat Oncol Biol Phys 71(1):87–97. doi:10.1016/j.ijrobp.2007.09.037 PubMedCrossRef

38.

Bauman GS, Sneed PK, Wara WM, Stalpers LJ, Chang SM, McDermott MW, Gutin PH, Larson DA (1996) Reirradiation of primary CNS tumors. Int J Radiat Oncol Biol Phys 36(2):433–441PubMedCrossRef

39.

Nieder C, Milas L, Ang KK (2000) Tissue tolerance to reirradiation. Semin Radiat Oncol 10(3):200–209PubMedCrossRef

Title: Adult medulloblastoma following fractionated proton therapy for acoustic neuroma
Authors: Mark N. Jabbour
Fady B. Geara
Roula Hourani
Badih Adada
Jean G. Rebeiz
Mamdouha Ahdab-Barmada
Publication date: 01-03-2013
Publisher: Springer-Verlag
Published in: Journal of Radiation Oncology / Issue 1/2013
Print ISSN: 1948-7894
Electronic ISSN: 1948-7908
DOI: https://doi.org/10.1007/s13566-012-0080-5

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