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2015 ; 85
(12
): 1056-64
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Recurrent stroke in childhood cancer survivors
#MMPMID26311747
Fullerton HJ
; Stratton K
; Mueller S
; Leisenring WW
; Armstrong GT
; Weathers RE
; Stovall M
; Sklar CA
; Goldsby RE
; Robison LL
; Krull KR
Neurology
2015[Sep]; 85
(12
): 1056-64
PMID26311747
show ga
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.
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