The management of childhood cancer survivors at risk for stroke: A Delphi survey of regional experts

Kenney, Lisa B.; Ames, Bethany; Michaud, Alexis L.; Williams, David N.; Manley, Peter; Ullrich, Nicole J.

doi:10.1002/pbc.27394

Cited by 8 publications

(7 citation statements)

References 21 publications

(47 reference statements)

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“…The use of antiplatelet drugs for secondary prevention in previously irradiated brain tumor patients who experience an ischemic stroke is well accepted, even if dedicated studies in this population are lacking [ 43 ]. Conversely, the benefit of low-dose aspirin as primary prevention in patients who did not have an ischemic event remains unproven.…”

Section: Discussionmentioning

confidence: 99%

Late-onset vascular complications of radiotherapy for primary brain tumors: a case–control and cross-sectional analysis

et al. 2023

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Purpose Radiotherapy (RT) is a recognized risk factor for cerebrovascular (CV) disease in children and in adults with head and neck cancer. We aimed to investigate whether cerebral RT increases the risk of CV disease in adults with primary brain tumors (PBT). Methods We retrospectively identified adults with a supratentorial PBT diagnosed between 1975 and 2006 and with at least 10 years follow-up after treatment. We analyzed demographic, clinical, and radiological features with special attention to CV events. We also described CV events, vascular risk factors, and intracranial artery modifications in a cross-sectional study of irradiated patients alive at the time of the study. Results A total of 116 patients, treated with RT (exposed group), and 85 non-irradiated patients (unexposed group) were enrolled. Stroke was more frequent in irradiated PBT patients than in the unexposed group (42/116 (36%) vs 7/85 (8%); p < 0.001), with higher prevalence of both ischemic (27/116 (23%) vs 6/85 (7%); p = 0.004) and hemorrhagic (12/116 (10%) vs 1/85 (1%); p = 0.02) stroke. In the irradiated group, patients with tumors near the Willis Polygon were more likely to experience stroke (p < 0.016). Fourty-four alive irradiated patients were included in the cross-sectional study. In this subgroup, intracranial arterial stenosis was more prevalent (11/45, 24%) compared to general population (9%). Conclusions Stroke prevalence is increased in long-surviving PBT patients treated with cranial RT. Implications for cancer survivors CV events are frequent in long survivors of PBT treated with cerebral RT. We propose a check list to guide management of late CV complications in adults treated with RT for PBT.

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Section: Discussionmentioning

confidence: 99%

Late-onset vascular complications of radiotherapy for primary brain tumors: a case–control and cross-sectional analysis

et al. 2023

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“…This consensus‐building approach includes an iterative group survey process to achieve convergence of opinion. It is designed to identify and explore a range of alternative clinical options, to expose and explore underlying assumptions, to capture and evaluate professional opinions spanning a wide range of practice settings, and to work toward clinical consensus 6,7 . This methodology allows the investigation of clinical questions that could not practically be asked in more traditional randomized clinical trials due to the required size and cost of such a trial.…”

Section: Methodsmentioning

confidence: 99%

Management of childhood cancer survivors at risk for thyroid function abnormalities: A Delphi study

Welch

Ames

Cohen

et al. 2022

Pediatric Blood & Cancer

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Background: Thyroid function abnormalities can occur after treatment for childhood cancer. Evidence for the management of thyroid dysfunction among asymptomatic childhood cancer survivors (CCS) is lacking. We used a Delphi consensus methodology to expand guidelines for screening asymptomatic CCS at risk for thyroid dysfunction and explore recommendations for the clinical management of abnormal results.Procedure: A Delphi panel of 40 expert physicians representing oncology, endocrinology, and primary care participated in three rounds of anonymous, iterative questionnaires formatted as clinical scenarios. Consensus is defined as ≥ 90% of panelists agree with recommendation and disagreement as < 70% agree.Results: Panelists reached consensus that CCS treated with radiation including neck, total body, whole brain, brain including the hypothalamic-pituitary axis (HPA), and therapeutic meta-iodobenzylguanidine (MIBG) should have annual, lifelong screening using serum thyroid-stimulating hormone (TSH) and free T4 starting within one year off-treatment (98%). Panelists disagreed on continuing to screen CCS for thyroid dysfunction after immunotherapy associated with acute thyroid injury (31%-50%).There was also disagreement on indications for brain (17%-43%) or thyroid (50%-65%) imaging, laboratory tests to assess the HPA (29%-75%), and TSH threshold to initiate treatment of subclinical hypothyroidism. Lack of evidence was the most frequent

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“…Abdominal radiographs were initially performed for surveillance of patients with abdominal pain, but additional imaging studies such as right upper quadrant US or pelvic US were done in accordance with localization of the symptoms and corresponding differential diagnoses [ 8 ]. CT or MRI was performed when there was an indication to assess the tumor (primary or metastatic) extent or when further information that could not be assessed by radiographs or US was needed, such as complications related to pneumonia, pulmonary embolism, intra-abdominal abscess, or stroke with protocols tailored to the clinical question (e.g., CT chest with or without contrast, CT chest with pulmonary angiography, CT abdomen and pelvis with contrast, and MRI brain with diffusion and contrast) [ 4 , 9 – 11 ].…”

Section: Methodsmentioning

confidence: 99%

Emergency room imaging in pediatric patients with cancer: analysis of the spectrum and frequency of imaging modalities and findings in a tertiary cancer center and their relationship with survival

et al. 2021

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Background To assess the spectrum and frequency of modalities used for emergency room (ER) imaging and their findings in pediatric cancer patients and assess their relationship with survival. Methods Consecutive pediatric cancer patients that underwent imaging during an ER visit at our tertiary cancer center over a 5-year period were retrospectively analyzed. Imaging findings were considered positive when they were relevant to the ER presenting complaint. Imaging positivity was correlated with inpatient admission. Overall survival (OS) was assessed with Kaplan-Meier curves and uni- and multi-variate Cox proportional hazards model was used to identify significant factors associated with OS. Results Two hundred sixty-one patients (135 males and 126 females; median age 11 years [interquartile range 5–16 years] with 348 visits and a total of 406 imaging studies were included. Common chief complaints were related to the chest (100 [28.7 %]) and fever (99 [28.4 %]). ER imaging was positive in 207 visits (59.5 %), commonly revealing increased metastases (50 [14.4 %]), pneumonia (47 [13.5 %]), and other lung problems (12 [2.9 %]). Positive ER imaging was associated with inpatient admission (69.3 % [133/192] vs. 40.4 % [63/156], p < 0.01). Multivariate survival analysis showed that positive ER imaging (hazard ratio [HR] = 2.35 [95% CI 1.44–3.83, p < 0.01), admission (HR = 1.86 [95% CI 1.17–3.00], p < 0.01), number of ER visits (HR = 3.08 [95% CI 1.62–5.83], p < 0.01 for ≥ 3 visits) were associated with poorer survival. Conclusions Imaging was able to delineate the cause for ER visits in children with cancer in over half of the cases. Positive ER imaging was associated with admission and worse survival.

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The management of childhood cancer survivors at risk for stroke: A Delphi survey of regional experts

Cited by 8 publications

References 21 publications

Late-onset vascular complications of radiotherapy for primary brain tumors: a case–control and cross-sectional analysis

Late-onset vascular complications of radiotherapy for primary brain tumors: a case–control and cross-sectional analysis

Management of childhood cancer survivors at risk for thyroid function abnormalities: A Delphi study

Emergency room imaging in pediatric patients with cancer: analysis of the spectrum and frequency of imaging modalities and findings in a tertiary cancer center and their relationship with survival

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