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Late aggressive meningioma following prophylactic cranial irradiation for acute lymphoblastic leukaemia.

There is an increasing number of reports concerning the induction of late brain tumours in survivors of childhood acute lymphoblastic leukaemia (ALL). The overwhelming majority of these patients received aggressive combined modality treatment, including systemic and intrathecal chemotherapy (methotrexate) and prophylactic cranial irradiation [1]. The late appearing tumours include mainly astrocytomas of various grades, glioblastoma muliforme and meningiomas. Most of these tumours exhibit malignant histological features (pleomorphism, high cellularity, atypical mitoses) and an aggressive behaviour (multiplicity and recurrence), necessitating repeated resections and even re-irradiation [1–3]. The aetiology of these induced brain tumours is not solely related to radiation therapy components (total dose, daily fractionation) but also to prolonged exposure to neurotoxic chemotherapeutic agents and, possibly, to inherent genetic susceptibility.