TOPLINE:

In a cohort study, childhood cancer survivors had an elevated lifetime risk for meningioma (35-year cumulative incidence, 2.3%). High-dose cranial radiation therapy, younger age at diagnosis, female sex, and exposure to platinum agents or intrathecal chemotherapy were each linked to an increased risk.

METHODOLOGY:

• Advances in childhood cancer treatment have increased the number of survivors who face health risks later in life. Meningiomas are the most common central nervous system (CNS) tumor among adult survivors of childhood cancer, yet few studies have looked at their incidence, risk factors, and outcomes.
• To investigate, researchers analyzed data from the Childhood Cancer Survivor Study, a longitudinal prospective follow-up of survivors diagnosed between 1970 and 1999 and treated at 31 institutions in the US and Canada.
• The analysis included 24,886 survivors who were alive 5 years or longer after a primary diagnosis of leukemia, CNS tumor, Hodgkin or non-Hodgkin lymphoma, Wilms tumor, neuroblastoma, soft tissue sarcoma, or bone tumor.
• The researchers tracked meningioma incidence and examined risk factors such as cranial radiation therapy dose, chemotherapy exposures, age at diagnosis, sex, and race or ethnicity.

TAKEAWAY:

• The cumulative incidence of subsequent meningioma was 2.3% at 35 years after childhood cancer diagnosis. Overall, 471 survivors were diagnosed with 710 meningiomas, and the median age at first diagnosis was 32 years.
• Exposure to cranial radiation therapy was associated with a dose-dependent increase in the risk for subsequent meningioma compared with no exposure: 1-29 Gy (hazard ratio [HR], 18.0), 30-49 Gy (HR, 76.5), and > 50 Gy (HR, 125.3).
• Meningioma risk also rose with exposures to platinum agents (HR, 2.2), 6-mercaptopurine (HR, 2.2), and intrathecal methotrexate (HR, 2.6) — all of which have been inconsistently associated with subsequent meningioma in prior studies, the authors noted.
• The younger the age at primary cancer diagnosis, the greater was the risk for meningioma later in life: 0-4 years (HR, 4.0), 5-9 years (HR, 2.7), and 10-14 years (HR, 1.86). Female sex was associated with an increased risk (HR, 1.6), while non-Hispanic Black survivors had a decreased risk compared with non-Hispanic White survivors (HR, 0.5).
• Regarding meningioma outcomes, all-cause cumulative mortality was 4.9%, 10.5%, and 18.4% at 5, 10, and 15 years, respectively, from the first meningioma diagnosis — with meningioma being the most prevalent cause of death (35.2%).

IN PRACTICE:

“The 15-year overall (18.4%) and subsequent meningioma-specific (5.4%) mortality rate reported in this study highlights the substantial risk of death and complex morbidity and mortality risks of this population,” the study authors wrote. Combined with previous reports, they concluded, the study “argues for assertive meningioma surveillance and treatment in this population.”

SOURCE:

The study, led by Daniel C. Bowers, MD, Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical School, Dallas, was published online in JAMA Network Open.

LIMITATIONS:

Subsequent meningiomas were initially identified through self-report, which may have led to underreporting of the true incidence. The study could not determine whether meningiomas were asymptomatic and detected on surveillance MRI. Additionally, germline data were not available, which limited assessment of inherited predisposition for meningioma risk among survivors. The study also lacked precise correlation between radiation dose to specific CNS locations and subsequent meningioma risk.

DISCLOSURES:

The study was supported by a grant from the National Cancer Institute. One author reported working as a medical director at Day One Biopharmaceuticals and Tango Therapeutics outside the submitted work. Some authors reported receiving grants from various sources. Full disclosures are noted in the original article.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.