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Pineal Tumors

 

 

Late Effects

Late Effects of Radiation Therapy (RT):

  • Occur 90 days to many years after RT 

Late Effects depend very much on:

  • Age of the child at therapy:
    • The younger the child, the more pronounced the toxicity is likely to be
  • Dose of RT:
    • Higher dose associated with increased toxicity
  • RT treatment field extent:
    • Craniospinal RT more damaging than focal field
  • Concurrent chemotherapy increases toxicity

Pineal tumors are often treated with craniospinal RT and a focal "boost" of RT to the site of the primary tumor.

 

Summary of Late Effects after radiation therapy for Pineal Tumors:

Therapy Late Toxicity

Craniospinal

RT (cranial portion of RT field) and cranial boost

Neurocognitive problems:

  • Poor short term memory
  • Difficulty with executive function

Depression:

  • Usually related to multiple long-term health problems and neurocognitive dysfunction

Hearing loss:

  • Direct RT related damage to the cochlea
  • Compounded sometimes by previous cisplatin

Pituitary and hypothalamic dysfunction:

Diabetes insipidus common in these patients as a direct effect of the tumor

Increased risk for cerebrovascular events (strokes):

  • RT effect on cerebral vasculature

Increased risk of second neoplasms:

Visual Problems:

  • Often related to underlying tumor and associated Parinauds syndrome
  • Cataracts (lens of the eye very sensitive to RT)

Sparse growth of scalp hair:

  • May especially affects area where "boost" of extra RT is given

Musculo-skeletal development:

  • Hypoplasia of cranium with mildly reduced head circumference if the child is young at the time of RT

Craniospinal

RT (spinal portion of RT field)

Thyroid damage is very common due to the "exit"

dose of the spinal field:

Spinal damage from RT effect on spinal growth:

  • Short sitting height (and therefore total height)
  • Scoliosis and kyphosis of spine leading to pain
  • Increased risk of early spinal arthritis and osteoporosis

Infertility:

  • Exit dose from lower end of spinal field damages ovaries or testicles

Cardiac damage:

  • Valvular stenosis from exit RT exit dose (rare)

Damage to bone marrow reserve:

  • After craniospinal RT, it is very difficult to tolerate further intensive chemotherapy
  • Bone marrow reserve is permanently damaged

 

Summary of Late Effects of tumor:

Direct tumor growth/pressure Late Toxicity
Pretectal area of brain

Parinaud's Syndrome usually does not resolve completely after the pineal tumor is treated.  Visual deficits include:

  • paralysis of upward gaze
  • reduced pupillary reflexes to light
  • convergence paresis 
Pituitary/Hypothalamus
  • Significant risk of diabetes insipidus and pituitary dysfuction secondary to tumor growth
  • This does not improve or resolve over time

 

Summary of Late Effects after chemotherapy for Pineal Tumors:

Chemotherapy Late Toxicity
Cisplatin & Carboplatin

Associated with:

 

 
Alkylating agents
Etoposide
  • Secondary AML (short latency period)

 

 

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