title: Late-occurring stroke among long-term survivors of childhood leukemia and brain tumors: a report from the Childhood Cancer Survivor Study.
abstract: OBJECTIVE
  This report examines the incidence of and risk factors for strokes that occur in > or = 5-year survivors of childhood leukemia and brain tumors.
  
  
  METHODS
  The rate of first occurrence of self-reported late-occurring strokes was determined for leukemia survivors (n = 4,828), brain tumor survivors (n = 1,871), and a comparison group of a random sample of cancer survivor siblings (n = 3,846). Relative risks (RRs) and 95% confidence intervals (CIs) of stroke by treatment exposures were examined by multivariate analyses.
  
  
  RESULTS
  Thirty-seven leukemia survivors and 63 brain tumor survivors reported a late-occurring stroke. The rate of late-occurring stroke for leukemia survivors was 57.9 per 100,000 person-years (95% CI, 41.2 to 78.7). The RR of stroke for leukemia survivors compared with the sibling comparison group was 6.4 (95% CI, 3.0 to 13.8; P < .0001). The rate of late-occurring stroke for brain tumor survivors was 267.6 per 100,000 person-years (95% CI, 206.8 to 339.2). The RR of stroke for brain tumor survivors compared with the sibling comparison group was 29.0 (95% CI, 13.8 to 60.6; P < .0001). Mean cranial radiation therapy (CRT) dose of > or = 30 Gy was associated with an increased risk in both leukemia and brain tumor survivors in a dose-dependent fashion, with the highest risk after doses of > or = 50 Gy CRT.
  
  
  CONCLUSIONS
  Survivors of childhood leukemia and brain tumors, particularly those with brain tumors treated with CRT at doses of greater than 30 Gy, are at an increased risk of stroke.
authors.affiliation: Department of Pediatrics, The University of Texas Southwestern Medical School, Dallas, TX 75390-9063, USA. Daniel.Bowers@utsouthwestern.edu
authors.forename: Daniel C
authors.initials: DC
authors.lastname: Bowers
authors.forename: Yan
authors.initials: Y
authors.lastname: Liu
authors.forename: Wendy
authors.initials: W
authors.lastname: Leisenring
authors.forename: Elizabeth
authors.initials: E
authors.lastname: McNeil
authors.forename: Marilyn
authors.initials: M
authors.lastname: Stovall
authors.forename: James G
authors.initials: JG
authors.lastname: Gurney
authors.forename: Leslie L
authors.initials: LL
authors.lastname: Robison
authors.forename: Roger J
authors.initials: RJ
authors.lastname: Packer
authors.forename: Kevin C
authors.initials: KC
authors.lastname: Oeffinger
mesh_terms: D000206:Actuarial Analysis; D000293:Adolescent; D000328:Adult; D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000009:adverse effects*; D001932:Brain Neoplasms / Q000175:diagnosis / Q000532:radiotherapy / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D016371:Cranial Irradiation / Q000009:adverse effects*; D004307:Dose-Response Relationship, Radiation; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D007938:Leukemia / Q000175:diagnosis / Q000532:radiotherapy / Q000628:therapy*; D008297:Male; D016017:Odds Ratio; D011879:Radiotherapy Dosage; D018570:Risk Assessment; D012307:Risk Factors; D035781:Siblings; D020521:Stroke / Q000453:epidemiology* / Q000209:etiology*; D017741:Survivors; D013997:Time Factors; D014481:United States
chemical_list: D000970:Antineoplastic Agents