A LARGE cohort study shows that meningiomas develop years later in a significant minority of survivors, with higher risks linked to treatment at earlier ages, radiation exposure, and certain chemotherapies.
Why Meningiomas Matter for Survivors
Meningiomas are typically slow growing brain tumours, but their impact can be substantial, particularly when they occur decades after childhood cancer treatment. Survivors of paediatric malignancies already face increased long term health risks, and meningiomas add to this burden through neurological symptoms, repeated interventions, and excess mortality. Understanding which survivors are most vulnerable is essential to guide follow up care. The new analysis addresses an important gap by examining meningiomas beyond early adulthood and identifying treatment-related risk factors that persist into midlife.
Tracking Meningiomas Across Decades of Follow Up
Researchers analysed data from the Childhood Cancer Survivor Study, a large retrospective cohort with prospective follow up, including 24 886 individuals diagnosed with cancer before age 21 years between 1970 and 1999. Among these survivors, 471 developed a total of 710 meningiomas. Thirty-five years after the original cancer diagnosis, the cumulative incidence of a subsequent meningioma was 2.3% (95% CI, 2.1%-2.6%). Of those affected, 137 survivors or 29.0% developed at least two meningiomas, and 80 or 16% met criteria for meningiomatosis. Risk was strongly associated with higher doses of cranial radiation therapy, with a hazard ratio of 125.3 (95% CI, 58.1-270.5). Younger age at primary cancer diagnosis also increased risk, particularly ages 0 to 4 years (HR, 4.0; 95% CI, 2.4-6.1), as did female sex (HR, 1.6; 95% CI, 1.3-1.9). Exposure to platinum chemotherapy, 6-mercaptopurine, and intrathecal chemotherapy further elevated risk. All cause cumulative mortality after a meningioma diagnosis reached 4.9% at 5 years, 10.5% at 10 years, and 18.4% at 15 years.
Implications For Clinical Practice and Screening
The findings suggest that meningiomas are not rare late effects among childhood cancer survivors and carry meaningful mortality risk. Clinicians should consider targeted surveillance for high-risk groups, particularly those treated with cranial radiation at a young age. Future guidelines may incorporate risk-based screening to detect meningiomas earlier and reduce long-term complications.
Reference
Bowers DC et al. Subsequent meningiomas among survivors of childhood cancer. JAMA Netw Open. 2025;8(12):e2548715.
