International Stroke Conference (ISC) 2012
Children Survive Cancer, but Face Stroke After Radiotherapy
February 13, 2012 (New Orleans, Louisiana) — Survivors of childhood cancer who were treated with cranial radiation therapy (CRT) are at high risk for future stroke beginning as early as their 20s, the results of 2 new studies suggest.
"Treatment with CRT increases the late-occurring stroke risk in a dose-dependent manner, and this risk continues to increase with age," said Sabine Mueller, MD, from the University of California, San Francisco, Benioff Children's Hospital, who presented both studies here at the International Stroke Conference (ISC) 2012.
More Than 14,000 Survivors Assessed
The first study was based on data from the Childhood Cancer Survivor Study, a multi-institutional longitudinal cohort study of 14,358 childhood cancer survivors diagnosed between 1970 and 1986, and 4023 randomly selected sibling control patients. Forty percent of the survivors were diagnosed by age 4 years, with 42% diagnosed between 5 and 14 years of age and 17% diagnosed between age 15 and 20 years of age.
During a mean follow-up of 23.3 years, 292 survivors reported a late-occurring stroke. Mean time from diagnosis to stroke was 18.6 years (range, 5 - 38 years), and median age at the time of stroke was 28.5 years (range, 6 - 53 years).
Of the 292 strokes, 125 (42.8%) occurred in survivors of central nervous system (CNS) tumors, who constituted only 13% of the survivor population, reported Dr. Mueller.
CRT increased the stroke risk in a dose-dependent manner, and the cumulative incidence continued to rise decades after diagnosis. Treatment with 30 to 49 Gy CRT had a relative stroke risk of 5.9 compared with 11.0 for 50+ Gy CRT (P < .0001).
The cumulative incidence of stroke 20 years after diagnosis was 0.7% for no CRT, 2.9% for 30 to 69.9 Gy CRT, and 4.9% for 50 Gy or more CRT. For the 50+ Gy group, cumulative incidence was 1.1% 10 years after diagnosis, rising to 11.9% at 30 years, Dr. Mueller added.
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