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radiation_induced_cerebral_cavernous_malformation

Radiation induced cerebral cavernous malformation

Radiation-induced cerebral cavernous malformation reflects post-irradiation impairment of cerebral microcirculation.

Radiation field size and dose were positively associated with the number of cavernous malformations developed. Cavernous malformations detected on MR imaging can be used as a surrogate marker for microvascular injury following intracranial irradiation in long-term cancer survivors 1).

The vast majority of radiation-induced CM is asymptomatic, and macro-hemorrhagic events occur rarely. Concomitant therapy with methotrexate seems to favor their development. Observation for asymptomatic lesions, while surgery should be reserved to symptomatic growth or hemorrhage 2).

Case series

2015

A study involved 34 patients with a history of intracranial germ cell tumors (GCTs) treated with either whole-brain or reduced-field irradiation and undergoing magnetic resonance (MR) imaging with a mean follow-up of 18.5years. The number of cavernous malformations on T2*-weighted MR images between whole-brain and reduced-field irradiation groups as well as between high- (50.2Gy) and low-dose (24.4Gy) fields were compared.

A total of 235 cavernous malformation lesions were observed in 32 of 34 patients (94.1%). The mean number of lesions was 2.3 times as high in the whole-brain group as in the reduced-field group (P=0.00296). The number of lesions in high-dose fields was significantly larger than in low-dose (P<0.000001) or untreated fields (P<0.001).

Radiation field size and dose were positively associated with the number of cavernous malformations developed. Cavernous malformations detected on MR imaging can be used as a surrogate marker for microvascular injury following intracranial irradiation in long-term cancer survivors 3).


Thirty-two patients with RICMs were identified (56.2% men), with a median age of 31.1 years at RICM diagnosis. The median latency from radiation treatment to RICM diagnosis was 12.0 years (interquartile range 5.0-19.6 years). RICMs were always within the previous radiation port. RICMs were symptomatic at diagnosis in 46.9%, and were associated with symptomatic intracranial hemorrhage at any time in 43.8%. Older age at the time of radiation treatment and higher radiation dose were associated with shorter latency. RICMs tended to be diagnosed at a younger age than nonradiation CMs (median 31.1 vs 42.4 years, respectively; p = 0.054) but were significantly less likely to be symptomatic at the time of diagnosis (46.9% vs 65.8%, respectively; p = 0.036). RICMs were more likely to be multiple CMs than nonradiation CMs (p = 0.0002). Prospectively, the risk of symptomatic hemorrhage was 4.2% for RICMs and 2.3% for nonradiation CMs per person-year (p = 0.556). In the absence of symptoms at presentation, the risk of hemorrhage for RICMs was higher than for nonradiation CMs (4.2% vs 0.35%, respectively; p = 0.118).

In this patient population, RICMs occurred within the radiation port approximately 12 years after radiation treatment. Compared with nonradiation CMs, RICMs were more likely to occur as multiple CMs, to present at a younger age, and were at least as likely to cause symptomatic hemorrhage 4).

Case reports

2013

An extremely rare case of meningioma and 15 cavernomas developing in a 29-year-old man, 19 years after cranial irradiation for posterior cranial fossa medulloblastoma. This is the first case of a radiation-induced meningioma accompanied by this many radiation-induced cavernous angiomas 5).


A boy treated for a CNS tumor (an infratentorial anaplastic ependymoma) after a short latency period between the end of radiotherapy and the development 6).

1) , 3)
Li L, Mugikura S, Kumabe T, Murata T, Mori E, Takase K, Jingu K, Takahashi S. A comparative study of the extent of cerebral microvascular injury following whole-brain irradiation versus reduced-field irradiation in long-term survivors of intracranial germ cell tumors. Radiother Oncol. 2015 Sep 16. pii: S0167-8140(15)00475-2. doi: 10.1016/j.radonc.2015.09.017. [Epub ahead of print] PubMed PMID: 26386986.
2)
Di Giannatale A, Morana G, Rossi A, Cama A, Bertoluzzo L, Barra S, Nozza P, Milanaccio C, Consales A, Garrè ML. Natural history of cavernous malformations in children with brain tumors treated with radiotherapy and chemotherapy. J Neurooncol. 2014 Apr;117(2):311-20. doi: 10.1007/s11060-014-1390-9. Epub 2014 Feb 11. PubMed PMID: 24515423.
4)
Cutsforth-Gregory JK, Lanzino G, Link MJ, Brown RD Jr, Flemming KD. Characterization of radiation-induced cavernous malformations and comparison with a nonradiation cavernous malformation cohort. J Neurosurg. 2015 May;122(5):1214-22. doi: 10.3171/2015.1.JNS141452. Epub 2015 Feb 20. PubMed PMID: 25699412.
5)
Chourmouzi D, Papadopoulou E, Kontopoulos A, Drevelegas A. Radiation-induced intracranial meningioma and multiple cavernomas. BMJ Case Rep. 2013 Sep 19;2013. pii: bcr2013010041. doi: 10.1136/bcr-2013-010041. PubMed PMID: 24051144; PubMed Central PMCID: PMC3794094.
6)
Martínez León MI. [Early magnetic resonance imaging detection of a cavernous angioma after cranial radiotherapy for an anaplastic ependymoma in a boy]. Radiologia. 2013 Nov-Dec;55(6):541-5. doi: 10.1016/j.rx.2010.12.018. Epub 2011 Jul 5. Spanish. PubMed PMID: 21733537.
radiation_induced_cerebral_cavernous_malformation.txt · Last modified: 2015/09/21 13:00 (external edit)