High incidence of secondary brain tumours after radiotherapy and antimetabolites

• Published in: The Lancet (British edition) 1999-07, Vol.354 (9172), p.34-39
• Main Authors: Relling, Mary V, Rubnitz, Jeffrey E, Rivera, Gaston K, Boyett, James M, Hancock, Michael L, Felix, Carolyn A, Kun, Larry E, Walter, Andrew W, Evans, William E, Pui, Ching-Hon
• Format: Article
• Language: English
• Subjects: Adolescent; Antimetabolites, Antineoplastic - adverse effects; Antimetabolites, Antineoplastic - therapeutic use; Biological and medical sciences; Brain; Brain Neoplasms - etiology; Brain tumors; Child; Child, Preschool; Children & youth; Combined Modality Therapy; Cranial Irradiation; Female; Follow-Up Studies; Humans; Incidence; Leukemia; Leukemia, Lymphoid - therapy; Male; Medical sciences; Metabolites; Neoplasms, Radiation-Induced - etiology; Neoplasms, Second Primary - etiology; Neurology; Pharmacokinetics; Radiation; Remission Induction; Risk Factors; Therapy; Tumors; Tumors of the nervous system. Phacomatoses
• ISSN: 0140-6736; 1474-547X
• DOI: 10.1016/S0140-6736(98)11079-6

Brain tumours rarely occur in survivors of childhood acute lymphoblastic leukaemia after cranial radiotherapy. An unusually high frequency of brain tumours seen among children enrolled in one of our leukaemia treatment protocols, Total Therapy Study XII, prompted us to identify the potential causes of this complication. We assessed clinical, biological, and pharmacokinetic features in all 52 children who received prophylactic cranial radiotherapy. We compared the cumulative incidence of brain tumours between subgroups, and with that of 421 children who received radiotherapy in previous studies. The incidence of brain tumours among irradiated children (six of 52, 12·8% [SE 5·0]) was high compared with patients in the same study who did not receive radiotherapy (none of 101; p=0·0008) and with other protocols that included cranial radiotherapy (p