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. 2013 Jul 15;86(4):643-8.
doi: 10.1016/j.ijrobp.2013.03.004. Epub 2013 Apr 23.

Risk of first and recurrent stroke in childhood cancer survivors treated with cranial and cervical radiation therapy

Sabine Mueller  1 , Katherine Sear, Nancy K Hills, Nassim Chettout, Shervin Afghani, Erica Gastelum, Daphne Haas-Kogan, Heather J Fullerton
Affiliations

Risk of first and recurrent stroke in childhood cancer survivors treated with cranial and cervical radiation therapy

Sabine Mueller et al. Int J Radiat Oncol Biol Phys. .

Abstract

Purpose: To assess, in a retrospective cohort study, rates and predictors of first and recurrent stroke in patients treated with cranial irradiation (CRT) and/or cervical irradiation at ≤18 years of age.

Methods and materials: We performed chart abstraction (n=383) and phone interviews (n=104) to measure first and recurrent stroke in 383 patients who received CRT and/or cervical radiation at a single institution between 1980 and 2009. Stroke was defined as a physician diagnosis and symptoms consistent with stroke. Incidence of first stroke was number of first strokes per person-years of observation after radiation. We used survival analysis techniques to determine cumulative incidence of first and recurrent stroke.

Results: Among 325 subjects with sufficient follow-up data, we identified 19 first strokes (13 ischemic, 4 hemorrhagic, 2 unknown subtype) occurring at a median age of 24 years (interquartile range 17-33 years) in patients treated with CRT. Imaging was reviewed when available (n=13), and the stroke was confirmed in 12. Overall rate of first stroke was 625 (95% confidence interval [CI] 378-977) per 100,000 person-years. The cumulative incidence of first stroke was 2% (95% CI 0.01%-5.3%) at 5 years and 4% (95% CI 2.0%-8.4%) at 10 years after irradiation. With each 100-cGy increase in the radiation dose, the stroke hazard increased by 5% (hazard ratio 1.05; 95% CI 1.01-1.09; P=.02). We identified 6 recurrent strokes; 5 had available imaging that confirmed the stroke. Median time to recurrence was 15 months (interquartile range 6 months-3.2 years) after first stroke. The cumulative incidence of recurrent stroke was 38% (95% CI 17%-69%) at 5 years and 59% (95% CI 27%-92%) at 10 years after first stroke.

Conclusion: Cranial irradiation puts childhood cancer survivors at high risk of both first and recurrent stroke. Stroke prevention strategies for these survivors are needed.

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Conflict of interest statement

Conflicts of Interest Notification:

None of the authors have any conflicts of interest to report.

Figures

Figure 1
Figure 1
Cumulative Incidence of First Stroke after Cranial Radiation Therapy in Pediatric Cancer Patients
Figure 2
Figure 2
(A) Cumulative Incidence of First Stroke after First Stroke in Pediatric Cancer Patients. (B) Depicted is the time from first to recurrent stroke for each patient with a histor of stroke recurrence (n=6)
See this image and copyright information in PMC

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