- 作者：Sabine Mueller ; MD ; PhD&lowast ; ; muellers@neuropeds.ucsf.edu ; Heather J. Fullerton ; MD ; MAS&dagger ; ; Kayla Stratton ; MS§ ; ; Wendy Leisenring ; ScD§ ; ; Rita E. Weathers ; MS? ; Marilyn Stovall ; PhD? ; Gregory T. Armstrong ; MD¶ ; ; Robert E. Goldsby ; MD&Dagger ; ; Roger J. Packer ; MD# ; Charles A. Sklar ; MD&lowast ; &lowast ; ; Daniel C. Bowers ; MD&dagger ; &dagger ; ; Leslie L. Robison ; PhD¶ ; ; Kevin R. Krull ; PhD¶ ;
- 刊名：International Journal of Radiation Oncology*Biology*Physics
- 出版年：2013
- 出版时间：15 July, 2013
- 年：2013
- 卷：86
- 期：4
- 页码：649-655
- 全文大小：415 K
Purpose
To test the hypotheses that (1) the increased risk of stroke conferred by childhood cranial radiation therapy (CRT) persists into adulthood; and (2) atherosclerotic risk factors further increase the stroke risk in cancer survivors.Methods and Materials
The Childhood Cancer Survivor Study is a multi-institutional retrospective cohort study of 14,358 5-year survivors of childhood cancer and 4023 randomly selected sibling controls with longitudinal follow-up. Age-adjusted incidence rates of self-reported late-occurring (¡Ý5 years after diagnosis) first stroke were calculated. Multivariable Cox proportional hazards models were used to identify independent stroke predictors.
Results
During a mean follow-up of 23.3 years, 292 survivors reported a late-occurring stroke. The age-adjusted stroke rate per 100,000 person-years was 77 (95 % confidence interval [CI] 62-96), compared with 9.3 (95 % CI 4-23) for siblings. Treatment with CRT increased stroke risk in a dose-dependent manner: hazard ratio 5.9 (95 % CI 3.5-9.9) for 30-49 Gy CRT and 11.0 (7.4-17.0) for 50+ Gy CRT. The cumulative stroke incidence in survivors treated with 50+ Gy CRT was 1.1 % (95 % CI 0.4-1.8 % ) at 10 years after diagnosis and 12 % (95 % CI 8.9-15.0 % ) at 30 years. Hypertension increased stroke hazard by 4-fold (95 % CI 2.8-5.5) and in black survivors by 16-fold (95 % CI 6.9-36.6).
Conclusion
Young adult pediatric cancer survivors have an increased stroke risk that is associated with CRT in a dose-dependent manner. Atherosclerotic risk factors enhanced this risk and should be treated aggressively.