Radiation, Atherosclerotic Risk Factors, and Stroke Risk in Survivors of Pediatric Cancer: A Report From the Childhood Cancer Survivor Study

Journal Article · Mon Jul 15 00:00:00 EDT 2013 · International Journal of Radiation Oncology, Biology and Physics

DOI:https://doi.org/10.1016/J.IJROBP.2013.03.034· OSTI ID:22224523

Mueller, Sabine ^[1]; Fullerton, Heather J. ^[2]; Stratton, Kayla; Leisenring, Wendy ^[3]; Weathers, Rita E.; Stovall, Marilyn ^[4]; Armstrong, Gregory T. ^[5]; Goldsby, Robert E. ^[6]; Packer, Roger J. ^[7]; Sklar, Charles A. ^[8]; Bowers, Daniel C. ^[9]; Robison, Leslie L.; Krull, Kevin R. ^[5]

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1. Department of Neurology, Pediatrics and Neurosurgery, University of California, San Francisco, San Francisco, California (United States)
2. Department of Neurology and Pediatrics, University of California, San Francisco, San Francisco, California (United States)
3. Fred Hutchinson Cancer Research Center, Seattle, Washington (United States)
4. Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States)
5. St. Jude Children's Research Hospital, Memphis, Tennessee (United States)
6. Department of Pediatrics, University of California, San Francisco, San Francisco, California (United States)
7. Children's National Medical Center, Washington, District of Columbia (United States)
8. Memorial Sloan-Kettering Cancer Center, New York, New York (United States)
9. University of Texas Southwestern Medical School, Dallas, Texas (United States)

Purpose: To test the hypotheses that (1) the increased risk of stroke conferred by childhood cranial radiation therapy (CRT) persists into adulthood; and (2) atherosclerotic risk factors further increase the stroke risk in cancer survivors. Methods and Materials: The Childhood Cancer Survivor Study is a multi-institutional retrospective cohort study of 14,358 5-year survivors of childhood cancer and 4023 randomly selected sibling controls with longitudinal follow-up. Age-adjusted incidence rates of self-reported late-occurring (≥5 years after diagnosis) first stroke were calculated. Multivariable Cox proportional hazards models were used to identify independent stroke predictors. Results: During a mean follow-up of 23.3 years, 292 survivors reported a late-occurring stroke. The age-adjusted stroke rate per 100,000 person-years was 77 (95% confidence interval [CI] 62-96), compared with 9.3 (95% CI 4-23) for siblings. Treatment with CRT increased stroke risk in a dose-dependent manner: hazard ratio 5.9 (95% CI 3.5-9.9) for 30-49 Gy CRT and 11.0 (7.4-17.0) for 50+ Gy CRT. The cumulative stroke incidence in survivors treated with 50+ Gy CRT was 1.1% (95% CI 0.4-1.8%) at 10 years after diagnosis and 12% (95% CI 8.9-15.0%) at 30 years. Hypertension increased stroke hazard by 4-fold (95% CI 2.8-5.5) and in black survivors by 16-fold (95% CI 6.9-36.6). Conclusion: Young adult pediatric cancer survivors have an increased stroke risk that is associated with CRT in a dose-dependent manner. Atherosclerotic risk factors enhanced this risk and should be treated aggressively.

• OSTI ID: 22224523
• Journal Information: International Journal of Radiation Oncology, Biology and Physics, Vol. 86, Issue 4; Other Information: Copyright (c) 2013 Elsevier Science B.V., Amsterdam, The Netherlands, All rights reserved.; Country of input: International Atomic Energy Agency (IAEA); ISSN 0360-3016
• Country of Publication: United States
• Language: English

Related Subjects

62 RADIOLOGY AND NUCLEAR MEDICINE
DIAGNOSIS
HEALTH HAZARDS
HYPERTENSION
NEOPLASMS
PEDIATRICS
RADIATION DOSES
RADIOTHERAPY