Nonperioperative strokes in children with central nervous system tumors

Abstract

BACKGROUNDNonperioperative strokes are rare yet potentially devastating events for children with central nervous system (CNS) tumors. The incidence of and risk factors for nonperioperative strokes in children with CNS tumors is unknown.METHODSThe authors performed a retrospective review of children from their institution with CNS tumors. The incidence of stroke in the nonperioperative period and the influence of patient demographic factors, coexisting genetic diseases, tumor type, and treatment modality on the subsequent occurrence of a stroke were determined.RESULTSEight hundred seven consecutive patients from the authors' institution with CNS tumors were observed for a combined 3224 nonperioperative years. Thirteen patients (1.6%) had a nonperioperative stroke, for an incidence of 4.03 strokes/1000 years of nonperioperative patient follow‐up. Eight patients were males, and the median age at diagnosis of a CNS tumor was 4.8 years (range, 0.3–18.6 years). The median duration from diagnosis of a CNS tumor until the occurrence of stroke was 2.3 years (range, 0.3–15.8 years). Among numerous potential risk factors individually examined by chi‐square analysis, only treatment with radiation therapy was associated with the subsequent development of a stroke (chi‐square, P = 0.007). By logistic regression analysis, treatment with radiation therapy and a diagnosis of an optic pathway glioma were the only statistically significant variables associated with a stroke.CONCLUSIONSStrokes are much more common among children with CNS tumors. Children treated with radiation therapy and those with optic pathway gliomas have a higher association with the occurrence of a subsequent nonperioperative stroke. Because children with optic pathway gliomas may be at particularly high risk of stroke after radiation therapy, the desired beneficial therapeutic effects of irradiation must always be weighed against its potentially adverse effects, including stroke. Cancer 2002;94:1094–101. © 2002 American Cancer Society.DOI 10.1002/cncr.10353

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Adult growth hormone replacement therapy and neuroimaging surveillance in brain tumour survivors

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Cardiovascular disease associated with radiotherapy: activation of nuclear factor kappa-B

“…An increased risk of stroke has been reported after cranial radiotherapy for brain tumours in childhood or adolescence [23, 24] as well as after neck radiotherapy for Hodgkin’s disease and head and neck cancer treatment in adults [25–28]. In general, these studies have been small, making it impossible to establish associations between the radiation dose and risk of stroke.…”