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Title: Cerebrovascular Diseases in Childhood Cancer Survivors: Role of the Radiation Dose to Willis Circle Arteries

Abstract

Background and Purpose: The aim of this study was to investigate the role of radiation dose received to the circle of Willis (WC) during radiation therapy (RT) and of potential dose-response modifiers on the risk of stroke after treatment of childhood cancer. Methods: We evaluated the risk factors for stroke in a cohort of 3172 5-year survivors of childhood cancer who were followed up for a median time of 26 years. Radiation doses to the WC and brain structures were estimated for each of the 2202 children who received RT. Results: Fifty-four patients experienced a confirmed stroke; 39 were ischemic. Patients not receiving RT had a stroke risk similar to that of the general population, whereas those who received RT had an 8.5-fold increased risk (95% confidence interval [CI]: 6.3-11.0). The excess of incidence of stroke increased yearly. The dose of radiation to the WC, rather than to other brain structures, was found to be the best predictor of stroke. The relative risk was 15.7 (95% CI: 4.9-50.2) for doses of 40 Gy or more. At 45 years of age, the cumulative stroke incidence was 11.3% (95% CI: 7.1%-17.7%) in patients who received 10 Gy or more to the WC, compared with 1% expectedmore » from general population data. Radiation doses received to the heart and neck also increased the risk. Surgery for childhood brain cancer was linked to hemorrhagic strokes in these patients. Conclusion: The WC should be considered as a major organ at risk during RT for childhood brain cancers. The incidence of radiation-induced ischemic stroke strongly increases with long-term follow-up.« less

Authors:
; ; ; ; ; ; ; ; ;  [1];  [2];  [2];  [3];  [4];  [1];  [2];  [1]; ;  [4]; more »;  [5];  [6];  [7]; « less
  1. Inserm U1018, Villejuif (France)
  2. (France)
  3. Institut Curie, Paris (France)
  4. Gustave Roussy, Villejuif (France)
  5. Registre Dijonnais des accidents vasculaires cérébraux, Dijon (France)
  6. Centre Alexis Vautrin, Vandoeuvre-lès-Nancy (France)
  7. Centre Léon Bérard, Lyon (France)
Publication Date:
OSTI Identifier:
22645764
Resource Type:
Journal Article
Resource Relation:
Journal Name: International Journal of Radiation Oncology, Biology and Physics; Journal Volume: 97; Journal Issue: 2; Other Information: Copyright (c) 2016 Elsevier Science B.V., Amsterdam, The Netherlands, All rights reserved.; Country of input: International Atomic Energy Agency (IAEA)
Country of Publication:
United States
Language:
English
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; BRAIN; GY RANGE 01-10; GY RANGE 10-100; NEOPLASMS; PATIENTS; RADIATION DOSES; RADIATION HAZARDS; RADIOTHERAPY

Citation Formats

El-Fayech, Chiraz, Haddy, Nadia, Allodji, Rodrigue Sètchéou, Veres, Cristina, Diop, Fara, Kahlouche, Amar, Llanas, Damien, Jackson, Angela, Rubino, Carole, Guibout, Catherine, Gustave Roussy, Villejuif, University of Paris XI, Villejuif, Pacquement, Hélène, Oberlin, Odile, Thomas-Teinturier, Cécile, Hôpital Bicêtre, Le Kremlin Bicêtre, Scarabin, Pierre-Yves, Chavaudra, Jean, Lefkopoulos, Dimitry, Giroud, Maurice, Bejot, Yannick, Bernier, Valérie, Carrie, Christian, and and others. Cerebrovascular Diseases in Childhood Cancer Survivors: Role of the Radiation Dose to Willis Circle Arteries. United States: N. p., 2017. Web. doi:10.1016/J.IJROBP.2016.10.015.
El-Fayech, Chiraz, Haddy, Nadia, Allodji, Rodrigue Sètchéou, Veres, Cristina, Diop, Fara, Kahlouche, Amar, Llanas, Damien, Jackson, Angela, Rubino, Carole, Guibout, Catherine, Gustave Roussy, Villejuif, University of Paris XI, Villejuif, Pacquement, Hélène, Oberlin, Odile, Thomas-Teinturier, Cécile, Hôpital Bicêtre, Le Kremlin Bicêtre, Scarabin, Pierre-Yves, Chavaudra, Jean, Lefkopoulos, Dimitry, Giroud, Maurice, Bejot, Yannick, Bernier, Valérie, Carrie, Christian, & and others. Cerebrovascular Diseases in Childhood Cancer Survivors: Role of the Radiation Dose to Willis Circle Arteries. United States. doi:10.1016/J.IJROBP.2016.10.015.
El-Fayech, Chiraz, Haddy, Nadia, Allodji, Rodrigue Sètchéou, Veres, Cristina, Diop, Fara, Kahlouche, Amar, Llanas, Damien, Jackson, Angela, Rubino, Carole, Guibout, Catherine, Gustave Roussy, Villejuif, University of Paris XI, Villejuif, Pacquement, Hélène, Oberlin, Odile, Thomas-Teinturier, Cécile, Hôpital Bicêtre, Le Kremlin Bicêtre, Scarabin, Pierre-Yves, Chavaudra, Jean, Lefkopoulos, Dimitry, Giroud, Maurice, Bejot, Yannick, Bernier, Valérie, Carrie, Christian, and and others. Wed . "Cerebrovascular Diseases in Childhood Cancer Survivors: Role of the Radiation Dose to Willis Circle Arteries". United States. doi:10.1016/J.IJROBP.2016.10.015.
@article{osti_22645764,
title = {Cerebrovascular Diseases in Childhood Cancer Survivors: Role of the Radiation Dose to Willis Circle Arteries},
author = {El-Fayech, Chiraz and Haddy, Nadia and Allodji, Rodrigue Sètchéou and Veres, Cristina and Diop, Fara and Kahlouche, Amar and Llanas, Damien and Jackson, Angela and Rubino, Carole and Guibout, Catherine and Gustave Roussy, Villejuif and University of Paris XI, Villejuif and Pacquement, Hélène and Oberlin, Odile and Thomas-Teinturier, Cécile and Hôpital Bicêtre, Le Kremlin Bicêtre and Scarabin, Pierre-Yves and Chavaudra, Jean and Lefkopoulos, Dimitry and Giroud, Maurice and Bejot, Yannick and Bernier, Valérie and Carrie, Christian and and others},
abstractNote = {Background and Purpose: The aim of this study was to investigate the role of radiation dose received to the circle of Willis (WC) during radiation therapy (RT) and of potential dose-response modifiers on the risk of stroke after treatment of childhood cancer. Methods: We evaluated the risk factors for stroke in a cohort of 3172 5-year survivors of childhood cancer who were followed up for a median time of 26 years. Radiation doses to the WC and brain structures were estimated for each of the 2202 children who received RT. Results: Fifty-four patients experienced a confirmed stroke; 39 were ischemic. Patients not receiving RT had a stroke risk similar to that of the general population, whereas those who received RT had an 8.5-fold increased risk (95% confidence interval [CI]: 6.3-11.0). The excess of incidence of stroke increased yearly. The dose of radiation to the WC, rather than to other brain structures, was found to be the best predictor of stroke. The relative risk was 15.7 (95% CI: 4.9-50.2) for doses of 40 Gy or more. At 45 years of age, the cumulative stroke incidence was 11.3% (95% CI: 7.1%-17.7%) in patients who received 10 Gy or more to the WC, compared with 1% expected from general population data. Radiation doses received to the heart and neck also increased the risk. Surgery for childhood brain cancer was linked to hemorrhagic strokes in these patients. Conclusion: The WC should be considered as a major organ at risk during RT for childhood brain cancers. The incidence of radiation-induced ischemic stroke strongly increases with long-term follow-up.},
doi = {10.1016/J.IJROBP.2016.10.015},
journal = {International Journal of Radiation Oncology, Biology and Physics},
number = 2,
volume = 97,
place = {United States},
year = {Wed Feb 01 00:00:00 EST 2017},
month = {Wed Feb 01 00:00:00 EST 2017}
}