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Benign Tumors with a Not-so-benign Impact: Meningiomas in Childhood Cancer Survivors

GregoryAuneby Gregory Aune, MD, PhD, CKN Editor


Childhood Cancer Survivors have their own unique set of issues that often go unaddressed by health care professionals once treatment has ended and the child enters adulthood.  Although the last 20 years have seen growth in survivorship research, this research is rarely filtered down to the people who need it most – the survivors and their families.  Dr. Gregory Aune, Pediatric Oncologist, researcher, childhood cancer survivor and advocate, has taken on the position of CKN Editor, Knowledge Translation – Childhood Cancer Survivorship.  His goal is simple:  to help empower childhood cancer survivors to start a dialogue with their doctors by publishing short, easy-to-read research study summaries, like this one.


THE HEADLINE:  Cranial radiotherapy linked to subsequent meningiomas in childhood cancer survivors


THE RESEARCH: Journal of Clinical Oncology: Morbidity and Mortality Associated With Meningioma After Cranial Radiotherapy: A Report From the Childhood Cancer Survivor Study. Researchers in the United States compiled data from the Childhood Cancer Survivors Study (CCSS) on 4,221 childhood cancer survivors that received cranial radiotherapy as part of their cancer treatments. No previous studies have evaluated the neurologic morbidity and overall impact of benign meningiomas in survivor populations. Therefore, the overall goal of this study was to evaluate the factors associated with neurologic sequelae after radiation-induced meningioma.


KEY FINDINGS:  Within the 4,221 radiation-exposed survivors, 169 meningiomas were identified in 169 participants. By age 40, the cumulative incidence of secondary meningiomas was 5.6%. A higher dose of cranial radiation was correlated with an increased risk of developing a secondary meningioma. Interestingly, within 6 months of a secondary meningioma diagnosis (either before or after), 20% of patients reported new onset neurologic morbidities including seizures (8.3%), auditory/visual/vestibular deficits (6%), or focal neurologic deficits (7.1%). The identified meningioma cases had a median follow-up of 72-months and within that timespan 22 were deceased, including 6 deaths attributed to a meningioma. Cancer survivors diagnosed younger than age 5 had a higher risk of developing a meningioma by age 40 and female survivors with a meningioma diagnosis were more likely to develop neurologic complications.


WHAT THIS MEANS FOR CHILDHOOD CANCER SURVIVORS:  While the risk of developing secondary meningiomas in radiation-exposed childhood cancer survivors has been clearly demonstrated, the morbidity and mortality associated with these benign tumors have not previously been quantified. This study highlights a significant risk of meningiomas in radiation-exposed childhood cancer survivors and an associated high rate of neurologic complications. Moreover, females, survivors who received radiation exposure under age 5, and those survivors that received higher doses of radiation were at greatest risk. For survivors in these groups it is critical to be aware of the possible significance of symptoms such as persistent headaches, vision changes, dizziness, and hearing problems, as these may be an indication for further evaluation to rule out a meningioma. Survivors with a history of cranial radiation exposure should have consistent annual surveillance, since a secondary meningioma in some instances is ultimately fatal. Although not yet proven, consistent screening is likely to reduce both the frequency of neurologic complications and mortality in this subset of childhood cancer survivors.



Medical Disclaimer:  The information on this site is not intended or implied to be a substitute for professional medical advice, diagnosis or treatment. All content, including text, graphics, images and information, contained on or available through this web site is for general information purposes only.  If you feel the research summarized applies to you or someone you know, talk to your doctor about your concerns.



Videos with Dr. Aune

Presentation on YouTube (Jan 2015):  Eliminating Long-term Health Effects in Cancer Survivors – Gregory Aune, MD, PhD

Interview for the National Coalition for Cancer Survivorship (June 2015):  Hodgkin’s Lymphoma Survivor Dr. Greg Aune Discusses Issues in Long-Term Survivorship Care

Interview with the Washington Post Live Summit (Dec 2016): How cancer lives on in young adults after treatment ends



Dr. Gregory J. Aune is the Stephanie Edlund Distinguished Professor of Pediatric Cancer Research and a St. Baldrick’s Foundation Scholar.  His experience in pediatric cancer spans over 27 years and encompasses his own patient experiences, research in experimental therapeutics, clinical care of pediatric oncology patients, and childhood cancer advocacy.  His interest in pediatric oncology began at age 16, when he was diagnosed with Hodgkin’s lymphoma.  While fortunate to survive, the experiences he encountered as a patient initiated a path towards a research and clinical career aimed at developing less toxic chemotherapy regimens.  His experience as a long-term survivor included open-heart surgery at age 35 to replace his aortic valve and bypass three blocked coronary arteries that were damaged by his teenage cancer therapies.  This life-changing event initiated his research interest in cardiac disease.  His training to become a successful physician scientist and pediatric oncologist has included time spent at some of the most well-respected oncology institutions in the United States including, M.D. Anderson Cancer Center, the National Cancer Institute, and Johns Hopkins Hospital.

Dr. Aune is a national leader in childhood cancer advocacy efforts.  In San Antonio, he has been a leader in local fundraising and awareness efforts.   Since 2010, he has spearheaded efforts by the St. Baldrick’s Foundation and For the Kids Dance Marathon at the University of Texas San Antonio that have raised over $830,000 for childhood cancer patients and research efforts.  In September 2014, his appointment to the National Cancer Institute Council of Research Advocates (NCRA) was announced by NCI Director Dr. Harold Varmus at a White House briefing on childhood cancer.

In addition, Dr. Aune is a policy advisor for the National Coalition for Cancer Survivorship, serves on the Board of Directors of the American Childhood Cancer Organization, is a member of the St. Baldrick’s Foundation National Advocacy Committee, and serves on the scientific advisory board for the Canines-N-Kids foundation.

In May 2015, Dr. Aune addressed the 68th World Health Assembly in Geneva, Switzerland and called on the World Health Organization to make childhood cancer a top global health priority.



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