Radiation treatment of benign tumors in NF2-related-schwannomatosis: A national study of 266 irradiated patients showing a significant increase in malignancy/malignant progression
Author:
Evans D Gareth12, Halliday Dorothy3, Obholzer Rupert4, Afridi Shazia5, Forde Claire1, Rutherford Scott A6, Hammerbeck-Ward Charlotte6, Lloyd Simon K6, Freeman Simon M6, Pathmanaban Omar N672, Thomas Owen M6, Laitt Roger D6, Stivaros Stavros892, Kilday John-Paul1011, Vassallo Grace1, McBain Catherine122, Lavin Timothy6, Paterson Chay1, Whitfield Gillian101112, McCabe Martin G1112, Axon Patrick R13, Halliday Jane3, Mackeith Samuel3, Parry Allyson3, Axon Patrick, Buttimore Juliette, Tysome James, Donnelly Neil, Borsetto Daniele, Whitworth James, Hensiek Anke, Jena Rajesh, Guilfoyle Mathew, Mannion Richard, Nicholson James, Muthusamy Brinda, Taylor Amy, Price Richard, Edme Karine, Gamazo Nicola, Vanat Zebunnisa, Scoffings Daniel, Scott Josh, Jefferies Sarah, Knight Richard, Lamb Tamara, Chuen Tam Yu, Foweraker Karen, Harris Fiona, Sanghera Paul, Meade Sara, Irving Richard, Monksfield Peter, Ragge Nicola, Murrell Melanie, Barwell Julian, English Martin, Trivedi Rikin, Afridi Shazia K, Ferner Rosalie E, Obholzer Rupert, Williams Victoria, Hammond Chris, Lascelles Karine, Skilbeck Chris, Shaw Adam, Swampillai Angela, Thomson Suki, Thomas Nick, Maratos Eleni, Barazi Sinan, Mullin Rebecca, Henley Susie, Smith Natalie, Carlton-Jones Lal, Baker Alison, Myers Mandy, Nunn Terry, Nduka Charles, Anup Raji, Duff Chris, Freeman Simon R, Jarvis Nicola, Kamaly-Asl Ian, King Andrew T, Kellett Mark, Kilday John-Paul, Lloyd Simon K, McBain Catherine, Laitt Roger, O’Driscoll Martin, McCabe Martin, Perry Mary, Rutherford Scott A, Henshaw Kirsty, Stivaros Stavros M, Thomas Owen, Vassallo Grace, Hammerbeck-Ward Charlotte L, Pathmanaban Omar N, Kurian Jincy, Lavin Tim, Harkness Elaine F814, Buttimore Juliette13, King Andrew T6215,
Affiliation:
1. Division of Evolution and Genomic Medicine, Manchester Centre for Genomic Medicine, Manchester Academic Health Science Centre, University of Manchester, St Mary’s Hospital, Manchester Universities NHS Foundation Trust , Manchester , UK 2. Geoffrey Jefferson Brain Research Centre, Manchester Academic Health Science Centre, Northern Care Alliance NHS Foundation Trust, University of Manchester , UK 3. Departments of Genomic Medicine, Neurology, Neurosurgery, ENT, Oxford University Hospitals NHS Foundation Trust 4. Department of ENT, and Neurology , London , UK 5. Guy’s and St Thomas’ NHS Trust , London , UK 6. Departments of Neurosurgery, Otolaryngology, Neuroradiology, and Neurology, Manchester Centre for Clinical Neurosciences Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust , Manchester , UK 7. Division of Neuroscience and Experimental Psychology, Faculty of Biology, Medicine and Health, University of Manchester , UK 8. Division of Informatics, Imaging and Data Sciences, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre , Oxford Road, Manchester, M13 9PL , UK 9. Academic Unit of Paediatric Radiology, Royal Manchester Children’s Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre , Manchester , UK 10. Children’s Brain Tumour Research Network (CBTRN), Royal Manchester Children’s Hospital , Manchester , UK 11. Division of Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester , UK 12. The Christie NHS Foundation Trust , Manchester , UK 13. Department of Otolaryngology, Cambridge University Hospitals NHS Foundation Trust , Cambridge , UK 14. Prevent Breast Cancer Centre, Wythenshawe Hospital, Manchester Universities NHS Foundation Trust , Manchester , UK 15. Division of Cardiovascular Sciences, Faculty of Biology, Medicine and Health, University of Manchester , UK
Abstract
AbstractBackgroundRadiation treatment of benign tumors in tumor predisposition syndromes is controversial, but short-term studies from treatment centers suggest safety despite apparent radiation-associated malignancy being reported. We determined whether radiation treatment in NF2-related schwannomatosis patients is associated with increased rates of subsequent malignancy (M)/malignant progression (MP).MethodsAll UK patients with NF2 were eligible if they had a clinical/molecular diagnosis. Cases were NF2 patients treated with radiation for benign tumors. Controls were matched for treatment location with surgical/medical treatments based on age and year of treatment. Prospective data collection began in 1990 with addition of retrospective cases in 1969. Kaplan–Meier analysis was performed for malignancy incidence and survival. Outcomes were central nervous system (CNS) M/MP (2cm annualized diameter growth) and survival from index tumor treatment.ResultsIn total, 1345 NF2 patients, 266 (133-Male) underwent radiation treatments between 1969 and 2021 with median first radiotherapy age of 32.9 (IQR = 22.4–46.0). Nine subsequent CNS malignancies/MPs were identified in cases with only 4 in 1079 untreated (P < .001). Lifetime and 20-year CNS M/MP was ~6% in all irradiated patients—(4.9% for vestibular schwannomas [VS] radiotherapy) versus <1% in the non-irradiated population (P < .001/.01). Controls were well matched for age at NF2 diagnosis and treatment (Males = 133%–50%) and had no M/MP in the CNS post-index tumor treatment (P = .0016). Thirty-year survival from index tumor treatment was 45.62% (95% CI = 34.0–56.5) for cases and 66.4% (57.3–74.0) for controls (P = .02), but was nonsignificantly worse for VS radiotherapy.ConclusionNF2 patients should not be offered radiotherapy as first-line treatment of benign tumors and should be given a frank discussion of the potential 5% excess absolute risk of M/MP.
Funder
Dame Eleanor Peel Trust, Royal College of Surgeons of Edinburgh, and the BMA Foundation NHS NIHR Manchester Biomedical Research Centre Cancer Research UK ACED Alliance Early Detection Centre
Publisher
Oxford University Press (OUP)
Subject
Surgery,Oncology,Neurology (clinical)
Cited by
14 articles.
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