InTechOpen uses cookies to offer you the best online experience. By continuing to use our site, you agree to our Privacy Policy.

Medicine » Oncology » "Molecular Considerations and Evolving Surgical Management Issues in the Treatment of Patients with a Brain Tumor", book edited by Terry Lichtor, ISBN 978-953-51-2031-5, Published: March 25, 2015 under CC BY 3.0 license. © The Author(s).

Chapter 7

Radiation-Induced Glioma

By Ryuya Yamanaka and Azusa Hayano
DOI: 10.5772/59047

Article top

Radiation-Induced Glioma

Ryuya Yamanaka1 and Azusa Hayano1

1. Introduction

Radiation therapy is widely used for patients with intracranial tumors. However, there are many complications, including cerebral atrophy, calcifying microangiopathy, radiation necrosis, leukoencephalopathy and development of radiation-induced tumors [1-5]. Radiation-induced central nervous system (CNS) neoplasms are recognized in patients who have had therapeutic radiotherapy to the head or face [6]. Radiation-induced CNS neoplasms are rare, but the cumulative risk of brain tumor after therapeutic cranial irradiation is reported as 0.5-2.7% at 15 years [7]. Among radiation-induced CNS neoplasms, meningiomas are about 70%, gliomas about 20% and sarcomas less than 10% [4,6,8]. In children, high-grade gliomas are the most common radiation-induced tumor [9]. Type of post-radiation gliomas are glioblastoma (GBM) in 75% and anaplastic astrocytoma in 25% [7]. Brada et al. [6] described a relative risk of secondary glioma of 7.92 times higher than that of the normal non-irradiated population, with an average latency period to glioma diagnosis of 7 years, in 334 patients with pituitary lesions, irradiated to a median dose of 45 Gy for the sellar region. Cahan et al. [10] established criteria to diagnose a radiotherapy induced brain tumor. These criteria were modified in 1972 by Schrantz and Araoz [11] as follows:(1) the tumor must appear within the irradiated field; (2) the tumor was not present prior to the radiotherapy; (3) a sufficient latency period must elapse between irradiation and appearance of the tumor (usually>5 years); (4) the radiation induced tumor must be histologically proven and a different histological type from the original neoplasm treated by the radiation therapy.

2. Radiation-induced gliomas in the literature

In a review of the literature, 191 cases of radiation-induced glioma that analyzed in detail were identified in the period 1960-2014 [9,12-120]. The latency period from the irradiation to the onset of the secondary glioma ranged from 6 months to 50 years, with an average of 11.1 years. More than 40 Gy irradiation was delivered in 50% of cases, with an average of 37.2 Gy. As shown in Table 1, 29 grade II, 37 grade III and 97 grade IV gliomas had been reported, and no specific grade had been shown in other 28 cases. Grade II gliomas developed after 10.7 years, and grade IV gliomas developed after 10.6 years from the time of irradiation. The radiation dose of grade II gliomas for primary lesion is 29.7 Gy, grade III 37.4 Gy and grade IV 37.3 Gy, respectively. There was a significant difference of radiation dose between grade II and grade IV glioma (p<0.05). In Table 2 and 3, the relation of primary lesion and radiation dose, latency to radiation induced glioma occurrence, glioma grade are shown. The latency in acute lymphoblastic leukemia (ALL) / acute myeloblastic leukemia (AML), Hodgkin/non-Hodgkin lymphoma and cancer patients is short compared to that of intracranial and scalp lesion. And, the irradiated dose in ALL/AML patients is rather small compared to that of intracranial lesion. Patients with ALL/AML and Hodgkin/non-Hodgkin lymphoma are usually intensively treated with anticancer agents with carcinogenic effects, so the patients may suffer from glioma by the synergistic effects of prophylactic irradiation and chemotherapy.

WHO grade Number of cases Irradiated dose (Gy) Latency (years)
Grade II2929.7±18.410.7±7.7
Grade III3737.4±15.912.6±8.6
Grade IV9737.3±17.510.7±6.6

Table 1.

Radiation induced glioma

Number of cases Irradiated dose (Gy) Latency (years) Radiation induced glioma
Pituitary adenoma2052.2±12.713.5±7.5Grade III/IV 16, II 3
Craniopharyngioma1563.9±7.011.7±7.0Grade III/IV 13, II 1
Medulloblastoma1644.9±9.515.8±12.2Grade III/IV 12, II 4
Germ cell tumor1044.9±8.515.2±13.4Grade III/IV 9, II 1
Optic glioma/Retinoblastoma646.5±10.97.2±2.4Grade IV 6
Menigioma/Neurinoma638.4±14.210±5.7Grade III/IV 5, II 1
Low grade glioma1247.0±7.813.5±10.1Grade III/IV 11, II 1

Table 2.

Radiation induced glioma of intracranial primary lesion

Number of cases Irradiated dose (Gy) Latency (years) Radiation induced glioma
ALL/AML6423.6±7.68.6±3.9Grade III/IV 52, II 10
Hodgkin/non-Hodgkin Lymphoma 635.6±10.78±5.7Grade III/IV 6
Cancer660.5±15.48±3.2Grade III/IV 6
Scalp lesion
1412.2±12.115.5±9.2Grade III/IV 9, II 5

Table 3.

Radiation induced glioma of extracranial primary lesion

[i] - ALL: acute lymphoblastic leukemia, AML: acute myeloblastic leukemia

3. Genetic characteristics of radiation-induced glioma

In a patient reported by Gessi [36], the genetic alterations were p53 mutation (C to G transition at codon 176 of Exon 5), loss of heterozygosity (LOH) of 17p and 19q, O(6)-methylguanine DNA methyltransferase (MGMT) promoter methylation, and no amplification of epidermal growth factor receptor (EGFR). In Yang’s case [115], p53 mutation (deletion at codon 233 of Exon 7 and a C to G transition at codon 278 of Exon 8) and no amplification of EGFR were reported. In Tada’s case [104], 3-bp homozygous deletion in exon 7 of the p53 gene was described. In Kon’s case [58], although LOH and amplification of EGFR, phosphatase and tensin analog (PTEN) was not observed, LOH of 1p, K-ras, p16, p53 were observed. In Alexous’s two cases, LOH of 1p was found in both cases [15]. Nine radiation-induced high-grade gliomas were studied for possible molecular alterations in p53, PTEN, K-ras, EGFR, and p16 by Brat [121]. Exon 8 of p53 gene mutation (G to A substitution in codon 285) is detected in one case, EGFR amplification in 2 cases and p16/ methylthioadenosine phosphorylase (MTAP) gene deletion in 2 cases [121]. However, genetic alterations similar to those described in spontaneous, sporadic primary GBM, except the absence of PTEN mutations in the radiation-induced group were found. Radiation-induced GBMs have a lower percent of EGFR and p16 alterations than primary GBM [121]. Donson et al. [122] demonstrated by gene expression analysis genetic homogenity relative to de-novo gliomas, suggesting a common precursor cell for radiation-induced gliomas. It is not well known about the molecular alteration of radiation-induced gliomas, due to the limited number of cases and limited genes were analyzed.

4. Therapeutic implications

Radiation-induced glioma is difficult to treat; radiotherapy is not always a therapeutic option because the patient has already been exposed to radiation. However there are several patients reported who had a sustained remission following chemotherapy alone or radiochemotherapy. About the reports of treatment of radiation-induced glioma, a dramatic response and prolonged survival by carmustine, nimustine hydrochloride and temozolomide were reported [52, 58, 71, 75]. These tumors have a poor prognosis due to their intrinsic resistance to treatment and the difficulty using aggressive therapies in previously irradiated patients. However, vigorous chemotherapeutic approaches may yield prolonged disease control in some patients with radiation-induced glioma. The relationship of 1p LOH and chemosensitivity in oligodendroglial tumors is well known [123]. 1p LOH may account for the marked response to chemotherapy [52,58], although the reason of the chemosensitivity is not discussed in other case. In Fukui’s case [32], 40 Gy of local radiotherapy and chemotherapy with nimustine hydrochloride and Interferone-β yielded dramatic response. The patient received 15 Gy of whole brain radiotherapy 7 years prior to the onset of radiation-induced glioma. Although the tolerable radiation dose is not well known after initial radiation therapy, additional radiotherapeutic approaches may yield prolonged disease control in some patients with radiation-induced glioma. The marked chemo and radiosensitivity should be further investigated for the development of glioma therapy.

5. Conclusion

In case that intracranial and extracranial lesions are treated by standard fractionated radiation or stereotatic radiosurgery, radiation-induced gliomas should be considered as possible long-term side effect. And the patients should be followed for a long term, even long after the period of risk for relapse of the primary site has passed.


1 - Mikhael MA. Radiation necrosis of the brain: correlation between patterns on computed tomography and dose of radiation. J Comput Assist Tomogr 1979;3(2):241-9.
2 - Jacoby CG, Tewfik HH, Blackwelder JT. Cerebellar atrophy developing after cranial irradiation. J Comput Assist Tomogr 1982;6(1):159-62.
3 - Dooms GC, Hecht S, Brant-Zawadzki M, Berthiaume Y, Norman D, Newton TH. Brain radiation lesions. MR imaging. Radiology 1986;158(1):149-55.
4 - Ron E, Modan B, Boice JD Jr, Alfandary E, Stovall M, Chetrit A, Katz L. Tumors of the brain and nervous system after radiotherapy in childhood. N Engl J Med 1988; 319(16):1033-9.
5 - Devivo DC, Malas D, Nelson JS, Land VJ. Leukoencephaly in childhood leukemia. Neurology 1997;27(7):609-13.
6 - Brada M, Ford D, Ashley S, Bliss JM, Crowley S, Mason M, Rajan B, Traish D. Risk of second brain tumour after conservative surgery and radiotherapy for pituitary adenoma. Br Med J 1992;304(6838):1343-6.
7 - Paulino AC, Mai WY, Chintagumpala M, Taher A, Teh BS. Radiation-induced malignant gliomas: is there a role for reirradiation? Int J Radiat Oncol Biol Phys 2008;71:1381-7.
8 - Musa BS, Pople IK, Cummins BH. Intracranial meningiomas following irradiation--a growing problem? Br J Neurosurg 1995;9(5):629-37.
9 - Pettorini BL, Park YS, Caldarelli M, Massimi L, Tamburrini G, Di Rocco C. Radiation-induced brain tumours after central nervous system irradiation in childhood: a review. Childs Nerv Syst 2008; 24: 793–805.
10 - Cahan WG, Woodard HQ, Higinbotham NL, Stewart FW, Coley EL. Sarcoma arising in irradiated bone; report of 11 cases. Cancer1948; 1(1):3-29.
11 - Schrantz JL, Araoz CA. Radiation induced meningeal fibrosarcoma. Arch Pathol 1972;93(1):26-31.
12 - Ahn SJ, Kim IO. Spinal cord glioblastoma induced by radiation therapy of nasopharyngeal rhabdomyosarcoma with MRI findings: case report. Korean J Radiol 2012;13(5):652-7.
13 - Albert RE, Omran AR, Brauer EW, Freed R. Follow-up study of patients treated by X-ray for tinea capitis. Am J Public Health 1966; 56:2114–20.
14 - Alexander MJ, DeSalles AA, Tomiyasu U. Multiple radiation-induced intracranial lesions after treatment for pituitary adenoma. Case report. J Neurosurg 1998;88(1):111-5.
15 - Alexiou GA, Moschovi M, Georgoulis G, Neroutsou R, Stefanaki K, Sfakianos G, Prodromou N. Anaplastic oligodendrogliomas after treatment of acute lymphoblastic leukemia in children: report of 2 cases. J Neurosurg Pediatr 2010;5(2):179-83.
16 - Anderson JR, Treip CS. Radiation-induced intracranial neoplasms: a report of three possible cases. Cancer 1984; 53:426–9.
17 - Bachman DS, Ostrow PT. Fatal long-term sequela following radiation “cure” for ependymoma. Ann Neurol 1978; 4:319–21.
18 - Balasubramaniam A, Shannon P, Hodaie M, Laperriere N, Michaels H, Guha A. Glioblastoma multiforme after stereotactic radiotherapy for acoustic neuroma: case report and review of the literature. Neuro Oncol 2007;9(4):447-53.
19 - Barnes ARE, Liwnicz BH, Schellhas HE, Altshuller G, Aron BS, Lippert WR. Successful treatment of placental choriocarcinoma metastatic to brain followed by primary brain glioblastoma. Gynecol Oncol 1982;13:108–14.
20 - Bazan C, New PZ, Kaghan-Hallet KS. MRI of radiation-induced spinal cord glioma. Neuroradiology 1990;32:331–3.
21 - Berman EL, Eade TN, Brown D, Weaver M, Glass J, Zorman G, Feigenberg SJ. Radiation-induced tumor after stereotactic radiosurgery for an arteriovenous malformation: case report. Neurosurgery 2007;61(5):E1099.
22 - Beute BJ, Fobben ES, Hubschmann O, Zablow A, Eanelli T, Solitare G. Cerebellar gliosarcoma: report of a probable radiation-induced neoplasm. AJNR 1991;12:554–6.
23 - Bonilha L, Borges G, Fernandes YB, Ramina R, Carelli EF, Alvarenga M. Pilocytic astrocytoma following radiotherapy for craniopharyngioma: case report. Arq Neuropsiquiatr 2000;58(3A):731-5.
24 - Chung CK, Stryker JA, Cruse R, Vanucci R, Towfighi J. Glioblastoma multiforme following prophylactic cranial irradiation and intrathecal methotrexate in a child with acute lymphoblastic leukaemia. Cancer 1980; 47:2563–6.
25 - Clifton MD, Amromin GD, Perry MC, Abadir R, Watts C, Levy N. Spinal cord glioma following irradiation for Hodgkin’s disease. Cancer 1980; 45:2051–5.
26 - Cohen MS, Kushner MJ, Dell S. Frontal lobe astrocytoma following radiotherapy for medulloblastoma. Neurology 1988; 31:616–9.
27 - Diersse G, Alvarez G, Figols J. Anaplastic astrocytoma associated with previous radiotherapy: report of three cases. Neurosurgery 1988; 6:1095–7.
28 - Doskaliyev A, Yamasaki F, Kenjo M, Shrestha P, Saito T, Hanaya R, Sugiyama K, Kurisu K. Secondary anaplastic oligodendroglioma after cranial irradiation: a case report. J Neurooncol 2008;88(3):299-303.
29 - Edwards MK, Terry JG, Montebello JF, Hornback NB, Kuharik MA. Gliomas in children following radiation therapy for lymphoblastic leukemia. Acta Radiol Suppl 1986;369:651-3.
30 - Enchev Y, Ferdinandov D, Kounin G, Encheva E, Bussarsky V. Radiation-induced gliomas following radiotherapy for craniopharyngiomas: a case report and review of the literature. Clin Neurol Neurosurg 2009;111(7):591-6.
31 - Fontana M, Stanton C, Pompili A, Amadori S, Mandelli F, Meloni G, Riccio A, Rubinstein LJ. Late multifocal gliomas in adolescents previously treated for lymphoblastic leukaemia. Cancer 1987; 60:1510–8.
32 - Fukui K, Inamura T, Nakamizo A, Ikezaki K, Inoha S, Nakamura K, Matsuzaki A, Fukui M. A case showing effective radiotherapy for a radiation-induced glioblastoma. No Shinkei Geka 2001;29(7):673-7.
33 - Fuller GN, Kaba SE, Ginsberg LE, McCutcheon IE, Langford LA. Late sequelae of treated pleomorphic xanthoastrocytoma: malignant brain stem astrocytoma occurring 15 years after radiation therapy. J Neurooncol 1997;32(1):57-61.
34 - Furuta T, Sugiu K, Tamiya T, Matsumoto K, Ohmoto T. Malignant cerebellar astrocytoma developing 15 years after radiation therapy for a medulloblastoma. Clin Neurol Neurosurg 1998;100(1):56-9.
35 - García-Navarro V, Tena-Suck ML, Celis MA, Vega R, Rembao D, Salinas C. Anaplastic astrocytoma post radiotherapy of pineal germinoma. Arq Neuropsiquiatr 2009;67(3A):707-9.
36 - Gessi M, Maderna E, Guzzetti S, Cefalo G, Massimino M, Solero CL, Finocchiaro G, Pollo B. Radiation-induced glioblastoma in a medulloblastoma patient: a case report with molecular features. Neuropathology 2008;28(6):633-9.
37 - Grabb PA, Kelly DR, Fulmer BB, Palmer C. Radiation-induced glioma of the spinal cord. Pediatr Neurosurg 1996;25:214–9.
38 - Guthjahr P, Dietrich E. Risiko zweiter maligner neoplasien nach erfolgreicher Tumorbehadlung in Kindersalter. Deutch Med Wochenshr 1979; 104:969–72.
39 - Hamasaki K, Nakamura H, Ueda Y, Makino K, Kuratsu J. Radiation-induced glioblastoma occurring 35 years after radiation therapy for medulloblastoma: case report. Brain Tumor Pathol 2010;27(1):39-43.
40 - Haselow RE, Nesbit M, Dehner LP, Knam FM, McHugh R, Lewitt SH. Second neoplasm following megavoltage radiation in a pediatric population. Cancer 1978; 42:1185–91.
41 - Hill MD, Mackenzie I, Mason WP. Radiation-induced glioma presenting as diffuse leptomeningeal gliomatosis: a case report. J Neurooncol 2001;55(2):113-6.
42 - Huang CI, Chiou WH, Ho DM. Oligodendroglioma occurring after radiation therapy for pituitary adenoma. J Neurol Neurosurg Psychiatry 1987;50(12):1619-24.
43 - Hufnagel TJ, Kim JH, Lesser R, Miller JM, Abrahams JJ, Piepmeier J, Manuelidis EE. Malignant glioma of optic chiasm eight years after radiotherapy for prolactinoma. Arch Ophtalmol 1988;106:1701–5.
44 - Jones A. Supervoltage X-ray therapy after of intracranial tumors. Ann R Soc Surg Eng1960;27:310–54.
45 - Judge MR, Eden OB, O’Neill P. Cerebral glioma after cranial prophylaxis for acute lymphoblastic leukaemia. Br Med J (Clin Res Ed) 1984; 289:1038–9.
46 - Kaido T, Hoshida T, Uranishi R, Akita N, Kotani A, Nishi N, Sakaki T. Radiosurgery-induced brain tumor: case report. J Neurosurg 2001;95:710–3.
47 - Kamide T, Nakada M, Hayashi Y, Suzuki T, Hayashi Y, Uchiyama N, Kijima T, Hamada J. Radiation-induced cerebellar high-grade glioma accompanied by meningioma and cavernoma 29 years after the treatment of medulloblastoma: a case report. J Neurooncol 2010;100(2):299-303.
48 - Kaschten B, Flandroy P, Reznik M, Hainaut H, Stevenaert A. Radiation-induced gliosarcoma: case report and review of the literature. J Neurosurg 1995;83:154–62.
49 - Kato N, Kayama T, Sakurada K, Saino M, Kuroki A. Radiation-induced glioblastoma: a case report. No To Shinkei 2000;52:413–8.
50 - Kawaguchi S, Kashiwaba T, Koiwa M, Shimoyama M, Kobayashi N, Fukushi Y, Tokuda K. Two autopsied cases of radiation-induced gliosarcoma. No Shinkei Geka 1991;19(3):285-90.
51 - Kawanabe Y, Sawada M, Yukawa H, Ueda S, Sasaki N, Koizumi T, Kihara S, Hoshimaru M. Radiation-induced spinal cord anaplastic astrocytoma subsequent to radiotherapy for testicular seminoma. Neurol Med Chir (Tokyo) 2012;52(9):675-8.
52 - Khoo HM, Kishima H, Kinoshita M, Goto Y, Kagawa N, Hashimoto N, Maruno M, Yoshimine T. Radiation-induced anaplastic ependymoma with a remarkable clinical response to temozolomide: a case report. Br J Neurosurg 2013;27(2):259-61.
53 - Kikkawa Y, Suzuki SO, Nakamizo A, Tsuchimochi R, Murakami N, Yoshitake T, Aishima S, Okubo F, Hata N, Amano T, Yoshimoto K, Mizoguchi M, Iwaki T, Sasaki T. Radiation-induced spinal cord glioblastoma with cerebrospinal fluid dissemination subsequent to treatment of lymphoblastic lymphoma. Surg Neurol Int. 2013;4:27.
54 - Kitanaka C, Shitara N, Nakagomi T, Nakamura H, Genka S, Nakagawa K, Akanuma A, Aoyama H, Takakura K. Postradiation astrocytoma: report of two cases. J Neurosurg 1989;70:469–74.
55 - Kleriga E, Sher JH, Nallainathan SK, Stein SC, Sacher M. Development of cerebellar malignant astrocytoma at site of medulloblastoma treated 11 years earlier. J Neurosurg 1979;49:445–9.
56 - Komaki S, Komaki R, Chol H, Correa-Paz F. Radiation and drug-induced intracranial neoplasm with angiographic demonstration. Neurol Med Chir (Tokio) 1977;17:55–62.
57 - Komatsu F, Kawaguchi H, Tsugu H, Oshiro S, Komatsu M, Fukushima T, Nabeshima K, Inoue T. Radiation-induced astrocytoma with rapid malignant transformation: case report. Neurol Med Chir (Tokyo) 2011;51(3):243-6.
58 - Kon T, Natsumeda M, Taki T, Takahashi H, Fujii Y, Yamanaka R. Radiation-induced glioblastoma following radiotherapy for pituitary adenomas: marked response to chemotherapy. J Neurol Neurophysiol 2013;4:155.
59 - Lach M, Wallace CJ, Krcek J, Curry B. Radiation-associated gliosarcoma. Can Assoc Radiol J 1996;47(3):209-12.
60 - Leung J, Guiney M. Secondary tumours after prophylactic cranial irradiation. Australas Radiol 1996;40(1):43-4.
61 - Liwnicz BH, Berger TS, Liwnicz RG. Radiation associated gliomas. A report of four cases and analysis of postradiation tumors of the central nervous system. Neurosurgery 1985;17:436–45.
62 - Loeffler JS, Niemierko A, Chapman P. Second tumors after radiosurgery: tip of the iceberg or a bump in the road? Neurosurgery 2003; 52:1436–42.
63 - Maat-Schieman MLC, Bots GTAM, Thomeer RTWM. Malignant astrocytoma following radiotherapy for craniopharyngioma. Br J Radiol 1985; 58:480–2.
64 - Malde R, Jalali R, Muzumdar D, Shet T, Kurkure P. Gliosarcoma occurring 8 years after treatment for a medulloblastoma. Childs Nerv Syst 2004;20(4):243-6.
65 - Malone M, Lumley H, Erdohazi M. Astrocytoma as a second malignancy in patients with acute lymphoblastic leukaemia. Cancer 1986;57:1979–85.
66 - Marus G, Levin V, Rutherford GS. Malignant glioma following radiotherapy for unrelated primary tumors. Cancer 1986; 58:886–94.
67 - Matsumura H, Takimoto H, Shirata M, Hirata M, Ohnishi T, Hayakawa T. Glioblastoma following radiotherapy in a patient with tuberous sclerosis. Neurol Med Chir (Tokio) 1998; 38:287–91.
68 - McWhirter WR, Pearn JH, Smith H, O’Regan P. Cerebral astrocytoma as a complication of acute lymphoblastic leukaemia. Med J Aust 1986;45:96–7.
69 - Menon G, Nair S, Rajesh BJ, Rao BR, Radhakrishnan VV.Malignant astrocytoma following radiotherapy for craniopharyngioma. J Cancer Res Ther 2007;3(1):50-2.
70 - Miyazawa T, Aida S, Shima K. Hemorrhagic cerebellar anaplastic glioma appearing 12 years after prophylactic cranial radiotherapy for acute lymphocytic leukemia. Neurol Med Chir (Tokyo) 2008;48(3):126-30.
71 - Monje ML, Ramakrishna NR, Young G, Drappatz J, Doherty LM, Wen PY, Kesari S. Durable response of a radiation-induced, high-grade cerebellar glioma to temozolomide. J Neurooncol 2007;84(2):179-83.
72 - Myong NH, Park BJ. Malignant glioma arising at the site of an excised cerebellar hemangioblastoma after irradiation in a von Hippel-Lindau disease patient. Yonsei Med J 2009;50(4):576-81.
73 - Muzumdar DP, Desai K, Goel A. Glioblastoma multiforme following prophylactic cranial irradiation and intrathecal methotrexate on a child with acute lymphoblastic leukaemia: a case report. Neurol India 1999; 47:142–4.
74 - Ng C, Fairhall J, Rathmalgoda C, Stening W, Smee R. Spinal cord glioblastoma multiforme induced by radiation after treatment for Hodgkin disease. Case report. J Neurosurg Spine 2007;6(4):364-7.
75 - Nicolardi L, DeAngelis LM. Response to chemotherapy of a radiation-induced glioblastoma multiforme. J Neurooncol 2006;78(1):55-7.
76 - Nishio S, Morioka T, Inamura T, Takeshita I, Fukui M, Sasaki M, Nakamura K, Wakisaka S. Radiation-induced brain tumors: potential late complications of radiation therapy for brain tumors. Acta Neurochir 1998;140:763–70.
77 - Okamoto S, Handa H, Yamashita J. Post-irradiation brain tumors. Neurol Med Chir (Tokyo) 1985;25:528–33.
78 - Osumi AK, Mclendon RE, Tien RD, Friedman HS, Graham M, Hockenberger B, Halperin EC, Oakes WJ. Well differentiated astrocytoma occurring nine years after radiation therapy for medulloblastoma. Clin Neuropathol 1994;13(5):281-5.
79 - Palma L, Vagnozzi R, Annino L, Ciappetta P, Maleci A, Cantore GP. Post-radiation glioma in a child. Case report and review of the literature. Child’s Nervous System 1988;4:296–301.
80 - Pearl GS, Mirra SS, Miles ML. Glioblastoma multiforme occurring 13 years after treatment of a medulloblastoma. Neurosurgery 1980;6:546–51.
81 - Platt JH, Blue JM, Schold SC, Burger PC. Glioblastoma multiforme after radiotherapy for acromegaly. Neurosurgery 1983;13:85–9.
82 - Preissig SH, Bohmfalk GL, Reichel GW, Smith M. Anaplastic astrocytoma following radiation for a glomus jugulare tumor. Cancer 1979;43:2243–7.
83 - Raffel C, Edwards MSB, Davis RL, Albin AR. Postirradiation cerebellar glioma: case report. J Neurosurg 1985;63:300–3.
84 - Rappaport ZH, Loren D, Ben-Ahron A. Radiation-induced cerebellar glioblastoma multiforme subsequent to treatment of an astrocytoma of the cervical spinal cord. Neurosurgery 1991;4:606–8.
85 - Riffaud L, Bernard M, Lesimple T, Morandi X. Radiation-induced spinal cord glioma subsequent to treatment of Hodgkin's disease: case report and review. J Neurooncol 2006;76(2):207-11.
86 - Rimm IL, Li FC, Tarbell NJ, Winston KR, Sallan SE. Brain tumors after cranial irradiation for childhood acute lymphoblastic leukaemia: a 13-years experience from Dana-Farber Cancer Institute and The Children’s Hospital. Cancer 1987;59:1506–8.
87 - Rittinger O, Kranzinger M, Jones R, Jones N. Malignant astrocytoma arising 10 years after combined treatment of craniopharyngioma. J Pediatr Endocrinol Metab 2003; 16: 97–101.
88 - Robinson RG. A second brain tumor and irradiation. J Neurol Neurosurg Psychiatry 1978;41:1005–12.
89 - Saenger EL, Silverman FN, Sterling FT, Turner ME. Neoplasia following therapeutic irradiation for benign conditions in childhood. Radiology 1960;74:889–904.
90 - Saiki S, Kinouchi T, Usami M, Nakagawa H, Kotake T. Glioblastoma multiforme after radiotherapy for metastatic brain tumor of testicular cancer. Int J Urol 1997;4(5):527-9.
91 - Salvati M, D'Elia A, Melone GA, Brogna C, Frati A, Raco A, Delfini R. Radio-induced gliomas: 20-year experience and critical review of the pathology. J Neurooncol 2008;89(2):169-77.
92 - Sanders J, Sale GE, Ramberg R, Clift R, Buckner CD, Thomas ED. Glioblastoma multiforme in a patient with acute lymphoblastic leukaemia who received a marrow transplant. Transplant Proc 1982;14:770–4.
93 - Schmidbauer M, Budka H, Bruckner CD, Vorkapic P. Glioblastoma developing at the site of a cerebellar medulloblastoma treated six years earlier. J Neurosurg 1987;71:77–82.
94 - Shamisa A, Bance M, Nag S, Tator C, Wong S, Noren G, Guha A. Glioblastoma multiforme occurring in a patient treated with gamma knife surgery: case report and review of the literature. J Neurosurg 2001;94:816–21.
95 - Shapiro S, Mcaly JJ. Late anaplastic glioma in children previously treated for acute lymphoblastic leukaemia. Pediatr Neurosci 1989;15:176–89.
96 - Shapiro S, Mcaly JJ, Sartorius C. Radiation-induced intracranial malignant gliomas. J Neurosurg 1989;71:77–82.
97 - Shore RE, Albert RE, Pasternack BS. Follow-up study of patients treated by X-ray epilation for tinea capitis. Arch Environ Health 1976;31:21–8.
98 - Simmons NE, Laws ER Jr. Glioma occurrence after sellar irradiation: case report and review. Neurosurgery 1998;42(1):172-8.
99 - Snead OC, Acker JD, Morawetz RW, Benton JW. High resolution computerized tomography with coronal and sagittal reconstruction in the diagnosis of brain tumors in children. Childs Brain 1982; 9:1–9.
100 - Soffer D, Gomori JM, Pomeranz S, Siegal T. Gliomas following low dose irradiation to the head: report of three cases. J Neurooncol 1998;6:67–72.
101 - Sogg RL, Donaldson SS, Yorke CH. Malignant astrocytoma following radiotherapy for craniopharyngioma. J Neurosurg 1978;48:622–7.
102 - Suda Y, Mineura K, Kowada M, Ohishi H. Malignant astrocytoma following radiotherapy in pituitary adenoma: case report. No Shinkei Geka 1989;17(8):783-8.
103 - Tada M, Sawamura Y, Abe H, Iggo R. Homozygous p53 gene mutation in a radiation-induced glioblastoma 10 years after treatment for an intracranial germ cell tumor: a case report. Neurosurgery 1997;40:393–6.
104 - Tamura M, Misumi S, Kurosaki S, Shibasaki T, Ohye C. Anaplastic astrocytoma 14 years after radiotherapy for pituitary adenoma. No Shinkei Geka 1992;20(4):493-7.
105 - Tanriover N, Ulu MO, Sar M, Uzan M. Anaplastic oligoastrocytoma: previous treatment as a possible cause in a child with acute lymphoblastic leukemia. Childs Nerv Syst 2007;23(4):469-73.
106 - Tolnay M, Kaim A, Probst A, Ulrich J. Subependymoma of the third ventricle after partial resection of a craniopharyngioma and repeated postoperative irradiation. Clin Neuropathol 1996;15(2):63-6.
107 - Tomita H, Nogaki H, Shibata Y, Tamaki N. Brain stem glioma induced by radiotherapy: report of a case. No Shinkei Geka 1995;23:151–5.
108 - Tsang RW, Lapierre NJ, Simpson WJ, Brierley MB, Panzarella T, Smyth S. Glioma arising after radiation therapy for pituitary adenoma: a report of four patients and estimation of risk. Cancer 1993;72:2227–33.
109 - Tsutsumi S, Yasumoto Y, Ito M. Pediatric multicentric glioma occurring after cranial irradiation. J Clin Neurosci 2009;16(8):1086-8.
110 - Ushio Y, Anta N, Yoshimine T, Nagatami N, Mogami H. Glioblastoma after radiotherapy for craniopharyngioma: case report. Neurosurgery 1987;21:33–8.
111 - Utsunomiya A, Uenohara H, Suzuki S, Nishimura S, Nishino A, Arai H, Sakurai Y, Suzuki H. A case of anaplastic astrocytoma arising 8 years after initial treatment by partial resection and irradiation for central neurocytoma. No To Shinkei 2001;53(8):747-51.
112 - Walter AW, Hancock ML, Pui C-H, Hudson MM, Ochs J, Rivera G, Pratt C, Boyett J, Kun L. Secondary brain tumors in children treated for acute lymphoblastic leukaemia at St. Jude Children’s Research Hospital. J Clin Oncol 1998;16(12):3761–7.
113 - Walters TR. Childhood acute lymphocytic leukemia with a second neoplasm. Am J Pediatr Hematol Oncol 1979;1:285–7.
114 - Yang SY, Wang KC, Cho BK, Kim YY, Lim SY, Park SH, Kim IH, Kim SK. Radiation-induced cerebellar glioblastoma at the site of a treated medulloblastoma: case report. J Neurosurg 2005;102(4 Suppl):417-22.
115 - Yeung YF, Wong GK, Zhu XL, Ma BB, Hk NG, Poon WS. Radiation-induced spinal glioblastoma multiforme. Acta Oncol 2006;45(1):87-90.
116 - Yu J, Yong WH, Wilson D, Black KL. Glioblastoma induction after radiosurgery for meningioma. Lancet 2000;356:1576–7.
117 - Zagzag D, Miller DC, Cangiarella J, Allen JC, Greco MA. Brainstem glioma after radiation therapy for acute myeloblastic leukemia in a child with Down syndrome. Possible pathogenetic mechanisms. Cancer 1992;70(5):1188-93.
118 - Zampieri P, Zorat PL, Mingrino S, Soattin GB. Radiation-associated cerebral gliomas. Report of two cases and review of the literature. J Neurosurg Sci 1989;3:271–9.
119 - Zochodne DW, Cairncross JG, Arce FP, MacDonald JC, Blume WT, Girvin JP, Kaufmann JC. Astrocytoma following scalp radiotherapy in infancy. Can J Neurol Sci 1984;11:475–8.
120 - Zuccarello M, Sawaya R, DeCourten-Myers G. Glioblastoma after radiation therapy for meningioma: case report and review of the literature. Neurosurgery 1986;19:114–9.
121 - Brat DJ, James CD, Jedlicka AE, Connolly DC, Chang E, Castellani RJ, Schmid M, Schiller M, Carson DA, Burger PC. Molecular genetic alterations in radiation-induced astrocytomas. Am J Pathol1999; 154:1431–8.
122 - Donson AM, Erwin NS, Kleinschmidt-DeMasters BK, Madden JR, Addo-Yobo SO, Foreman NK. Unique molecular characteristics of radiation-induced glioblastoma. J Neuropathol Exp Neurol 2007;66(8):740-9.
123 - Thiessen B, Maguire JA, McNeil K, Huntsman D, Martin MA, Horsman D. Loss of heterozygosity for loci on chromosome arms 1p and 10q in oligodendroglial tumors: relationship to outcome and chemosensitivity. J Neurooncol 2003;64(3):271-8.