Possible Early Emergence of In-Field Second Neoplasms Following Cranial Irradiation, Chemotherapy, and Stereotactic Irradiation: Report of Two Cases

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We report two patients with intracranial mass lesions, both treated with initial external-beam cranial irradiation (EBRT), subsequent linear accelerator-based stereotactic irradiation, and chemotherapy, who developed second unrelated malignancies inside the field of both the conventional and the stereotactic irradiation within 13 months of completion of EBRT. One was a 48-year-old man with a right temporal glioblastoma who developed a neurofibrosarcoma of the ipsilateral temporal scalp, and the other was a 53-year-old woman who developed a glioblastoma that enveloped a previously successfully treated metastasis from a non–small cell lung primary. We believe that these cases may reflect radiation-induced neoplasms and that the early occurrence of such second malignancies may be a new toxicity attributable to the combination of stereotactic and conventional irradiation and, possibly, systemic chemotherapy.

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