Evaluation of the Impact of Magnetic Resonance Imaging with Susceptibility-weighted Imaging for Screening and Surveillance of Radiation-induced Cavernomas in Long-term Survivors of Malignancy.

Published on May 21, 2021in Clinical Oncology3.113
· DOI :10.1016/J.CLON.2021.04.010
Belinda A. Campbell16
Estimated H-index: 16
(Peter MacCallum Cancer Centre),
A. Lasocki (Peter MacCallum Cancer Centre)+ 9 AuthorsGreg Wheeler14
Estimated H-index: 14
(Peter MacCallum Cancer Centre)
Abstract Aims Radiation-induced cavernomas (RIC) are common late toxicities in long-term survivors of malignancy following cerebral irradiation. However, the natural history of RIC is poorly described. We report the first series of long-term surveillance of RIC using modern magnetic resonance imaging (MRI) including highly sensitive susceptibility-weighted imaging (SWI). The aims of this research were to better characterise the natural history of RIC and investigate the utility of MRI-SWI for screening and surveillance. Materials and methods Eligibility required long-term survivors of malignancy with previous exposure to cerebral irradiation and RIC identified on MRI-SWI surveillance. The number and size of RIC were reported on Baseline MRI-SWI and last Follow-up MRI-SWI. Results In total, 113 long-term survivors with RIC underwent MRI-SWI surveillance; 109 (96%) were asymptomatic at the time of RIC diagnosis. The median age at cerebral irradiation was 9.3 years; the median radiotherapy dose was 50.4 Gy. The median time from cerebral irradiation to Baseline MRI-SWI was 17.9 years. On Baseline MRI-SWI, RIC multiplicity was present in 89% of patients; 34% had >10 RIC; 65% had RIC ≥4 mm. The median follow-up from Baseline MRI-SWI was 7.3 years. On Follow-up MRI-SWI, 96% of patients had multiple RIC; 62% had >10 RIC; 72% had RIC ≥4 mm. Of the 109 asymptomatic patients at RIC diagnosis, 96% remained free from RIC-related symptoms at 10 years. Only two required neurosurgical intervention for RIC; there was no RIC-related mortality. Conclusions RIC are commonly multiple, asymptomatic and typically increase in size and number over time. Our findings suggest that MRI-SWI for screening of RIC is unlikely to influence longer term intervention in asymptomatic cancer survivors. In the absence of neurological symptoms, assessment or monitoring of RIC are insufficient indications for MRI-SWI surveillance for long-term survivors of malignancy with past exposure to cerebral irradiation.
📖 Papers frequently viewed together
102 Citations
#1Noriko KuriharaH-Index: 13
#2Hiroyoshi SuzukiH-Index: 61
Last. Hiroshi UenoharaH-Index: 16
view all 6 authors...
Cavernous malformation (CM) is the second most common cerebral vascular malformation and is often found incidentally. Their natural history is usually benign, however, patients with CM who present with symptomatic hemorrhage may later follow a serious clinical course if left untreated. The risk of hemorrhage is associated with previous hemorrhage, lesion location (infratentorial and deep), and the presence of associated developmental venous anomaly (DVA). Histopathological specimens also indicat...
3 CitationsSource
#1Louis S. Constine (URMC: University of Rochester Medical Center)H-Index: 70
#2Cécile M. Ronckers (Boston Children's Hospital)H-Index: 27
Last. Søren M. Bentzen (UMB: University of Maryland, Baltimore)H-Index: 102
view all 7 authors...
Abstract With advances in multimodality therapy, childhood cancer cure rates approach 80%. However, both radiotherapy and chemotherapy can cause debilitating or even fatal late adverse events that are critical to understand, mitigate or prevent. QUANTEC (Quantitative Analysis of Normal Tissue Effects in the Clinic) identified radiation dose constraints for normal tissues in adults and pointed out the uncertainties in those constraints. The range of adverse events seen in children is different fr...
30 CitationsSource
#1Vadim Khasminsky (Rabin Medical Center)H-Index: 2
#2Michal Yalon (Sheba Medical Center)H-Index: 14
Last. Chen Hoffmann (Sheba Medical Center)H-Index: 22
view all 6 authors...
Purpose The aim of this retrospective study is to investigate the value of the susceptibility-weighted imaging (SWI) sequence compared to gradient echo (GRE) in the detection and follow-up of cavernous malformations in patients who underwent whole-brain irradiation as part of their medulloblastoma treatment.
1 CitationsSource
#1Lucie M. TurcotteH-Index: 11
#2Joseph P. NegliaH-Index: 83
Last. Tara O. Henderson (U of C: University of Chicago)H-Index: 30
view all 10 authors...
Subsequent malignant neoplasms (SMNs) in childhood cancer survivors cause substantial morbidity and mortality. This review summarizes recent literature on SMN epidemiology, risk factors, surveillance, and interventions. Survivors of childhood cancer experience long-term increased SMN risk compared with the general population, with a greater than twofold increased solid tumor risk extending beyond age 40 years. There is a dose-dependent increased risk for solid tumors after radiotherapy, with the...
55 CitationsSource
#1João Passos (Instituto Português de Oncologia Francisco Gentil)H-Index: 3
#2Hipólito Nzwalo (University of the Algarve)H-Index: 10
Last. Duarte Salgado (Instituto Português de Oncologia Francisco Gentil)H-Index: 6
view all 10 authors...
Abstract Background With the expected growth and aging of the population of primary central nervous system tumours (PCNST) survivors, attention to the radiation-induced late brain injury is fundamental. Late focal hemosiderin deposition (FHD) lesions, namely microbleeds and cavernomas, are among the presumable late cerebrovascular complications associated with radiotherapy for PCNST. Objective To explore association between PCNST radiotherapy and the occurrence FHD lesions and to address the cor...
19 CitationsSource
#1Jacqueline Stone (MSK: Memorial Sloan Kettering Cancer Center)H-Index: 7
#2Lisa M. DeAngelis (MSK: Memorial Sloan Kettering Cancer Center)H-Index: 108
Neurotoxicity caused by treatment is widely recognized in patients with cancer. This Review addresses the main neurotoxicities of cancer treatment with a focus on the newer therapeutics. Recognition of these patterns of toxicity is important because drug discontinuation or dose adjustment might prevent further neurological injury. Familiarity with the neurological syndromes associated with cancer treatments enables clinicians to use the appropriate treatment for the underlying malignancy while m...
104 CitationsSource
Purpose: Adolescent and young adult (AYA) survivors of cancers in childhood experience cancer worry, defined as concerns about cancer-related issues such as relapse and late effects of treatment. Cancer worry is an important determinant of successful transition to long-term follow-up care. The primary aim of this study was to identify patient-, cancer-, and treatment-related factors associated with cancer worry in AYA survivors. A secondary aim was to explore and understand inappropriate cancer ...
19 CitationsSource
#1João Passos (Instituto Português de Oncologia Francisco Gentil)H-Index: 3
#2Hipólito NzwaloH-Index: 10
Last. Duarte SalgadoH-Index: 6
view all 7 authors...
Abstract Background Brain radiotherapy plays a central role in the treatment of certain types of childhood primary central nervous system tumors. However, damage to surrounding normal brain tissue causes different acute and chronic medical and neurological complications. Despite the expected increase in number of childhood primary central nervous system tumor survivors, studies assessing the occurrence of late cerebrovascular complications, such as cavernoma, moyamoya, microbleeds, superficial s...
23 CitationsSource
#1Erica Gastelum (UCSF: University of California, San Francisco)H-Index: 2
#2Katherine Sear (UCSF: University of California, San Francisco)H-Index: 6
Last. Sabine Mueller (UCSF: University of California, San Francisco)H-Index: 36
view all 11 authors...
Rates and characteristics of intracerebral cavernous malformations after cranial radiation therapy remain poorly understood. Herein we report on intracerebral cavernous malformations detected on follow-up imaging in pediatric cancer patients who received cranial radiation therapy at age ≤18 years from 1980 to 2009. Through chart reviews (n = 362) and phone interviews (n = 104) of a retrospective cohort, we identified 10 patients with intracerebral cavernous malformations. The median latency time...
22 CitationsSource
#2Giuseppe Lanzino (Mayo Clinic)H-Index: 60
Last. Kelly D. FlemmingH-Index: 29
view all 5 authors...
OBJECT The objective of this study was to characterize the clinical features of radiation-induced cavernous malformations (RICMs). METHODS The authors retrospectively reviewed the clinical and radiological characteristics of patients with RICMs. The features of these RICMs were then compared with features of nonradiation cavernous malformations (CMs) in 270 patients. RESULTS Thirty-two patients with RICMs were identified (56.2% men), with a median age of 31.1 years at RICM diagnosis. The median ...
51 CitationsSource
Cited By0