Recurrent stroke in childhood cancer survivors.
Fullerton, Heather J. MD, MAS; Stratton, Kayla MS; Mueller, Sabine MD, PhD; Leisenring, Wendy W. ScD; Armstrong, Greg T. MD; Weathers, Rita E. MS; Stovall, Marilyn PhD; Sklar, Charles A. MD; Goldsby, Robert E. MD; Robison, Les L. PhD; Krull, Kevin R. PhD
85(12):1056-1064, September 22, 2015.
(Format: HTML, PDF)
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.
(C) 2015 American Academy of Neurology