Recurrent stroke in childhood cancer survivors

Heather J. Fullerton, Kayla Stratton, Sabine Mueller, Wendy W. Leisenring, Gregory Armstrong, Rita E. Weathers, Marilyn Stovall, Charles A. Sklar, Robert E. Goldsby, Les L. Robison, Kevin R. Krull

Research output: Contribution to journalArticle

16 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)1056-1064
Number of pages9
JournalNeurology
Volume85
Issue number12
DOIs
StatePublished - Sep 22 2015

Fingerprint

Stroke
Neoplasms
Confidence Intervals
Radiotherapy
Hypertension
Radiation Dosage
Proportional Hazards Models
Cohort Studies
Retrospective Studies
Radiation
Pediatrics
Incidence

All Science Journal Classification (ASJC) codes

  • Clinical Neurology

Cite this

Fullerton, H. J., Stratton, K., Mueller, S., Leisenring, W. W., Armstrong, G., Weathers, R. E., ... Krull, K. R. (2015). Recurrent stroke in childhood cancer survivors. Neurology, 85(12), 1056-1064. https://doi.org/10.1212/WNL.0000000000001951

Recurrent stroke in childhood cancer survivors. / Fullerton, Heather J.; Stratton, Kayla; Mueller, Sabine; Leisenring, Wendy W.; Armstrong, Gregory; Weathers, Rita E.; Stovall, Marilyn; Sklar, Charles A.; Goldsby, Robert E.; Robison, Les L.; Krull, Kevin R.

In: Neurology, Vol. 85, No. 12, 22.09.2015, p. 1056-1064.

Research output: Contribution to journalArticle

Fullerton, HJ, Stratton, K, Mueller, S, Leisenring, WW, Armstrong, G, Weathers, RE, Stovall, M, Sklar, CA, Goldsby, RE, Robison, LL & Krull, KR 2015, 'Recurrent stroke in childhood cancer survivors', Neurology, vol. 85, no. 12, pp. 1056-1064. https://doi.org/10.1212/WNL.0000000000001951
Fullerton HJ, Stratton K, Mueller S, Leisenring WW, Armstrong G, Weathers RE et al. Recurrent stroke in childhood cancer survivors. Neurology. 2015 Sep 22;85(12):1056-1064. https://doi.org/10.1212/WNL.0000000000001951
Fullerton, Heather J. ; Stratton, Kayla ; Mueller, Sabine ; Leisenring, Wendy W. ; Armstrong, Gregory ; Weathers, Rita E. ; Stovall, Marilyn ; Sklar, Charles A. ; Goldsby, Robert E. ; Robison, Les L. ; Krull, Kevin R. / Recurrent stroke in childhood cancer survivors. In: Neurology. 2015 ; Vol. 85, No. 12. pp. 1056-1064.
@article{dd5366f4e17144d7a6ee349f81783fe3,
title = "Recurrent stroke in childhood cancer survivors",
abstract = "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.",
author = "Fullerton, {Heather J.} and Kayla Stratton and Sabine Mueller and Leisenring, {Wendy W.} and Gregory Armstrong and Weathers, {Rita E.} and Marilyn Stovall and Sklar, {Charles A.} and Goldsby, {Robert E.} and Robison, {Les L.} and Krull, {Kevin R.}",
year = "2015",
month = "9",
day = "22",
doi = "10.1212/WNL.0000000000001951",
language = "English (US)",
volume = "85",
pages = "1056--1064",
journal = "Neurology",
issn = "0028-3878",
publisher = "Lippincott Williams and Wilkins",
number = "12",

}

TY - JOUR

T1 - Recurrent stroke in childhood cancer survivors

AU - Fullerton, Heather J.

AU - Stratton, Kayla

AU - Mueller, Sabine

AU - Leisenring, Wendy W.

AU - Armstrong, Gregory

AU - Weathers, Rita E.

AU - Stovall, Marilyn

AU - Sklar, Charles A.

AU - Goldsby, Robert E.

AU - Robison, Les L.

AU - Krull, Kevin R.

PY - 2015/9/22

Y1 - 2015/9/22

N2 - 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.

AB - 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.

UR - http://www.scopus.com/inward/record.url?scp=84947920700&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84947920700&partnerID=8YFLogxK

U2 - 10.1212/WNL.0000000000001951

DO - 10.1212/WNL.0000000000001951

M3 - Article

VL - 85

SP - 1056

EP - 1064

JO - Neurology

JF - Neurology

SN - 0028-3878

IS - 12

ER -