Tumors of the Brain and Nervous System after Radiotherapy in Childhood

We investigated the relation between radiotherapy in childhood for tinea capitis and the later development of tumors of the brain and nervous system among 10,834 patients treated between 1948 and 1960 in Israel. Benign and malignant tumors were identified from the pathology records of all Israeli hospitals and from Israeli national cancer and death registries. Doses of radiation to the neural tissue were retrospectively estimated for each patient (mean, 1.5 Gy). Sixty neural tumors developed in the patients exposed as children, and the 30-year cumulative risk (±SE) was 0.8±0.2 percent. The incidence of tumors was 1.8 per 10,000 persons per year. The estimated relative risk as compared with that for 10,834 matched general-population controls and 5392 siblings who had not been irradiated was 6.9 (95 percent confidence interval, 4.1 to 11.6) for all tumors and 8.4 (confidence interval, 4.8 to 14.8) when the analysis was restricted to neural tumors of the head and neck. Increased risks were apparent for meningiomas (relative risk, 9.5; n = 19), gliomas (relative risk, 2.6; n = 7), nerve-sheath tumors (relative risk, 18.8; n = 25), and other neural tumors (relative risk, 3.4; n = 9). A strong dose–response relation was found, with the relative risk approaching 20 after estimated doses of approximately 2.5 Gy. Our study confirms that radiation doses on the order of 1 to 2 Gy can significantly increase the risk of neural tumors. (N Engl J Med 1988; 319:1033–9.) IT is no longer surprising that ionizing radiation can induce leukemia and other cancers in adults and children. 1 , 2 However, data concerning the effects of radiation on the nervous system are limited. In 1974, we reported a significant increase in brain tumors among 10,834 persons who had received cranial irradiation in childhood for tinea capitis. 3 This report extends the period of observation an additional 10 years and incorporates estimates of individual radiation doses to the brain. Few other studies have convincingly implicated radiation as a cause of cancers of the brain and nervous system. Because radiotherapy to the brain is commonly . . .