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Published on: April 21, 2017
Recurrent stroke in childhood cancer survivors
Heather J Fullerton1, Kayla Stratton1, Sabine Mueller2
1From the Departments of Neurology (H.J.F., S.M.), Pediatrics (H.J.F., S.M., R.E.G.), and Neurosurgery (S.M.), University of California, San Francisco; the Fred Hutchinson Cancer Research Center (K.S., W.W.L.), Clinical Statistics and Cancer Prevention Programs, Seattle, WA; St. Jude Children's Research Hospital (G.T.A., L.L.R., K.R.K.), Memphis, TN; the University of Texas M.D. Anderson Cancer Center (R.E.W., M.S.), Houston; and Memorial Sloan-Kettering Cancer Center (C.A.S.), New York, NY.
Insights
Childhood cancer survivors treated with high-dose cranial radiation face a high risk of recurrent stroke. Hypertension and older age at first stroke are key predictors, necessitating long-term monitoring.
Area of Science:
- Pediatric Oncology
- Neurology
- Cardiovascular Research
Background:
- Pediatric cancer survivors are at increased risk for long-term health complications.
- Stroke is a serious complication that can occur in this population.
- Understanding recurrent stroke risk is crucial for survivor management.
Purpose of the Study:
- To determine the incidence and identify predictors of recurrent stroke in pediatric cancer survivors.
- To analyze long-term stroke recurrence rates following an initial stroke event.
Main Methods:
- Retrospective cohort study utilizing data from the Childhood Cancer Survivor Study.
- Follow-up of 14,358 survivors diagnosed with cancer between 1970-1986.
- Survey of 443 survivors reporting a first stroke to identify recurrent events.
Main Results:
- Among 271 first stroke survivors, 70 reported a second stroke.
- High-dose cranial radiation therapy (≥50 Gy), hypertension, and older age at first stroke predicted recurrence.
- 10-year cumulative incidence of late recurrent stroke was 21% overall, and 33% for those receiving ≥50 Gy CRT.
Conclusions:
- Pediatric cancer survivors, especially those with high-dose cranial radiation exposure, have a substantial long-term risk of recurrent stroke.
- Hypertension is an independent predictor of recurrent stroke in this population.
- These findings highlight the need for vigilant, long-term cardiovascular monitoring in childhood cancer survivors.
Objective:
To estimate the rates and predictors of recurrent stroke among survivors of pediatric cancer who have had a first stroke.
Methods:
The Childhood Cancer Survivor Study is a retrospective cohort study with longitudinal follow-up that enrolled 14,358 survivors (<21 years old at diagnosis; diagnosed 1970-1986; survived ≥5 years after cancer diagnosis) and followed them prospectively since 1994. We surveyed 443 survivors who reported a first stroke to identify recurrent stroke, and estimated recurrent stroke rates ≥5 years after cancer diagnosis.
Results:
Among 329 respondents (74% response rate), 271 confirmed a first stroke at a median age of 19 years (range 0-53), and 70 reported a second stroke at a median age of 32 years (range 1-56). In a multivariable Cox proportional hazards model, independent predictors of recurrent stroke included cranial radiation therapy (CRT) dose of ≥50 Gy (vs none, hazard ratio [HR] 4.4; 95% confidence interval [CI] 1.4-13.7), hypertension (HR 1.9; 95% CI 1.0-3.5), and older age at first stroke (HR 6.4; 95% CI 1.8-23; for age ≥40 vs age 0-17 years). The 10-year cumulative incidence of late recurrent stroke was 21% (95% CI 16%-27%) overall, and 33% (95% CI 21%-44%) for those treated with ≥50 Gy of CRT.
Conclusion:
Survivors of childhood cancer, particularly those previously treated with high-dose cranial radiation, have a high risk of recurrent stroke for decades after a first stroke. Although these strokes are mostly occurring in young adulthood, hypertension, an established atherosclerotic risk factor, independently predicts recurrent stroke in this population.
