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Cancer research

Radiation-Induced Malignant Brain Tumors Raise Concerns in Pediatric Acute Lymphoblastic Leukemia Patients

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— 2 min read

Research conducted at Tohoku University Hospital in Sendai, Japan, has highlighted concerns about the risk of radiation-induced malignant brain tumors in pediatric patients with acute lymphoblastic leukemia (ALL). According to the study, two patients developed secondary glioblastoma, a rare and aggressive type of brain cancer, after undergoing radiation therapy for ALL. The median overall survival of adult patients with glioblastoma is approximately 12 months, and less than 5% of patients survive more than 5 years.

Key Takeaways:

  • Radiation therapy is a known risk factor for carcinogenesis and can increase the risk of secondary malignant neoplasms, including malignant brain tumors.
  • The cumulative risk of developing malignant brain tumors following prophylactic cranial radiation for ALL patients is estimated to be around 0.5%-1.5% at 15 years.
  • The most frequent tumor types of radiation-induced malignant brain tumors are meningioma, glioblastoma (GBM), and sarcoma.
  • GBM is classified as a high-grade glioma and is known for its poor prognosis, with a median overall survival of approximately 12 months.
  • The appropriate re-irradiation dose for patients with radiation-induced GBM is still controversial, as a more critical decision on the radiation dose needs to be made considering the increased incidence of brain necrosis with higher radiation doses.
  • A case report on two pediatric patients with secondary glioblastoma following radiotherapy for ALL has shed light on long-term survivors among pediatric RIGBM and the optimal radiation dose in the settings of re-irradiation.
  • Additional research is needed to determine the optimal radiation dose and treatment strategy for pediatric patients with RIGBM.

Statistics:

  • 0.5-1.5% cumulative risk of developing malignant brain tumors following prophylactic cranial radiation for ALL patients at 15 years (Relling et al., 1998).
  • 12 months median overall survival for adult patients with glioblastoma (Hertler et al., 2023).
  • 5% survival rate for patients with glioblastoma beyond 5 years (Hertler et al., 2023).
  • 50 Gy in 25 fractions for 5 weeks, 2 Gy in a dose per fraction, concurrent chemotherapy and external beam radiation, used in both patients (Case 1 and Case 2).

Sources:

  • Kamran et al., "Cancer. 122(12):1809-21, 2016"
  • Diallo et al., "Int J Radiat Oncol, 74(3):876-83, 2009"
  • Relling et al., "J Clin Oncol Off J Am Soc Clin Oncol, 16(12):3761-7, 1998"
  • Walter et al., "J Clin Oncol Off J Am Soc Clin Oncol, 16(12):3761-7, 1998"
  • Onishi et al., "2024"
  • Holland, "Proc Natl Acad Sci U.S.A 97(12):6242-4, 2000"
  • Louis et al., "Neuro-Oncol 23(8):1231-51, 2021"
  • Hertler et al., "Eur J Cancer 189:112,913, 2023"
  • Lawrence et al., "Int J Radiat Oncol 76(3):S20-7, 2010"
  • NewsRx. Tohoku University Hospital Reports Findings in Acute Lymphoblastic Leukemia (Two pediatric patients with secondary glioblastoma following radiotherapy for acute lymphoblastic leukemia: a case report). Pediatrics Week. June 21, 2025; p 605.

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