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Background: Most survivors of childhood acute lymphoblastic leukemia (ALL) and T-cell lymphoma (T-NHL) treated before 1990 received cranial radiation. This study assessed the occurrence of second tumors in irradiated and non-irradiated survivors., Methods: Two hundred and ten survivors of ALL and T-NHL were treated between 1974 and 1997 by several protocols. Imaging (MRI, CT) was performed every 3-6 years in 76/88 irradiated and 74/122 non-irradiated patients for the last 20 years., Results: From January 1998 through 2004, meningiomas were detected in 16 survivors (8 female, 8 male) at age 20-39 years (median 28.7); 15 were asymptomatic. Cranial imaging done 2-8 years previously in 11 revealed no abnormalities. Fifteen had been diagnosed with ALL or T-NHL 10-29 years earlier (median 21) and received cranial irradiation (24 Gy in 14) at age 2-14 years (median 7.6). Fifteen tumors arose in the convexity. Three patients had multiple lesions. Complete resection was performed in 12 patients, with one complication. One patient had a recurrence, and four with small tumors are under surveillance. Only one low-grade glioma and two basal-cell carcinomas were found. Only one of the 74 non-irradiated patients (median follow-up 14 years) developed meningioma. The Kaplan-Meier estimate of incidence of meningioma was 14.8+/-7.6 at 20 years., Conclusions: Survivors of childhood ALL treated with cranial radiation require prolonged surveillance because of a high incidence of late meningiomas. Early detection, when the tumor is still small, facilitates resection and may reduce complications., (Copyright (c) 2007 Wiley-Liss, Inc.)