Recurrent Stroke Risk in Childhood Cancer Survivors

Publication Type:

Journal Article


Neuro-Oncology, Oxford University Press, Volume 15, p.230–230 (2013)



2013, Clinical Research Division, February 2014, Public Health Sciences Division


BACKGROUND: Survivors of childhood cancer treated with cranial radiation therapy (CRT) are at high risk for first stroke. Little is known about rates and predictors of recurrent stroke in this population. METHODS: The Childhood Cancer Survivor Study (CCSS) is a multi-institutional retrospective cohort of 14,358 five-year survivors of childhood cancer ({\ensuremath{<}}21 years old at cancer diagnosis; treated from1970-1986), and 4,023 randomly selected sibling controls with ongoing, longitudinal follow up. CCSS participants (or their proxy) periodically completed comprehensive questionnaires on demographics and medical conditions. We surveyed 334 survivors plus 109 proxies of deceased survivors who previously reported stroke, to identify recurrent strokes. We estimated recurrent stroke rates using cumulative incidence and evaluated associations with risk factors using Cox regression. RESULTS: Among 329 respondents (proxy report n = 76), 271 confirmed a first stroke. Median age at time of first stroke was 19 years and 119 (44) carried an original diagnosis of CNS tumor. A second stroke was reported in 70 patients (26) at median age of 32 years (range 1, 56). Of these, 37 (53) were reported in CNS tumor survivors. Median time from first to recurrent stroke was 2 years (range 0,31). The 10-year cumulative incidence of recurrent stroke was 21 (95 CI 16, 27) overall, and 33 (21, 44) for those treated with {\ensuremath{>}}50 Gy of CRT. Independent predictors of stroke recurrence included: CRT dose {\ensuremath{>}}50 Gy (compared to none, hazard ratio HR 4.4; 95% CI, 1.4-13.7), hypertension (HR 1.9; 95% CI, 1.0-3.5), and age ? 40 years at time of first-stroke (HR 6.4; 95% CI 1.8-23; for the comparison of age ?40 to age 0-17). CONCLUSIONS: Survivors of childhood cancer who suffer a first stroke are at high risk for recurrent stroke, particularly those treated with high-dose CRT. Hypertension independently increases the risk of stroke recurrence in this population.