Researchers assess predictors and long-term incidence rates of stroke among childhood cancer survivors.
SAVANNAH, GA—Children with brain tumors, leukemia, or Hodgkin’s disease have an increased risk for stroke, which continues for decades after the initial diagnosis, according to research presented at the 40th National Meeting of the Child Neurology Society.
Results are based on the Childhood Cancer Survivor Study, a multi-institutional cohort trial that compared childhood cancer survivors of five years or more with a sibling comparison group. The researchers, led by Sabine Mueller, MD, PhD, Assistant Clinical Professor of Neurology at the University of California, San Francisco, Medical Center, calculated age-adjusted incidence rates of self-reported first stroke for 1,876 participants who had had a brain tumor, 4,830 who had had leukemia, and 1,927 who had had Hodgkin’s disease.
Data were compared with 4,023 sibling controls with the use of multivariable Poisson regression models. The investigators used Multivariable Cox Proportional Hazards models to identify independent predictors of stroke.
Dr. Mueller and her research colleagues found that 125 patients who had survived a brain tumor, 71 who had survived leukemia, and 44 who had survived Hodgkin’s disease reported a stroke as an adult. The age-adjusted stroke rate per 100,000 person-years at age 22 was 279 for those who had had a brain tumor, 49 for those who had had leukemia, and 23 for those who had had Hodgkin’s disease, compared with a rate of 8.2 for siblings.
Brain tumor survivors had a relative stroke risk of 30.1, leukemia survivors had a relative risk of 8.2, and Hodgkin’s disease survivors had a relative risk of 4.4, compared with siblings.
“Treatment with radiation increased the stroke risk, and this risk continues to increase with longer follow-up from diagnosis,” reported Dr. Mueller. “The cumulative incidence of stroke in brain tumor survivors treated with 50-Gy radiation was 1.3% after 10 years, compared with 14.2% after 30 years.
—Colby Stong