title: Cranial irradiation increases risk of stroke in pediatric brain tumor survivors.
abstract: OBJECTIVE
  The purposes of this study were to determine the incidence of neurovascular events as late complications in pediatric patients with brain tumor and to evaluate radiation as a risk factor.
  
  
  METHODS
  Patients were ascertained using the tumor database of a pediatric tertiary care center. Included patients had a primary brain tumor, age birth to 21 years, initial treatment January 1, 1993, to December 31, 2002, and at least 2 visits with neuro-oncology. Radiation exposure included: whole brain, whole brain plus a focal boost, or focal brain. The primary outcome was stroke or transient ischemic attack.
  
  
  RESULTS
  Of 431 subjects, 14 had 19 events of stroke or transient ischemic attack over a median follow-up of 6.3 years. The incidence rate was 548/100 000 person-years. Overall, 61.5% of subjects received radiation, including 13 of 14 subjects with events. Median time from first radiation to first event was 4.9 years. The stroke/transient ischemic attack hazard ratio for any brain irradiation was 8.0 (95% CI, 1.05-62; P=0.045); for the circle of Willis, radiation was 9.0 (95% CI, 1.2-70; P=0.035); and for focal noncircle of Willis, radiation was 3.4 (95% CI, 0.21-55; P=0.38).
  
  
  CONCLUSIONS
  The incidence of neurovascular events in this population is 100-fold higher than in the general pediatric population and cranial irradiation is an important risk factor. By defining the incidence of this late effect, physicians are better able to counsel parents regarding treatment, monitor patients at risk, and target a population for primary stroke prevention in future studies.
authors.affiliation: Department of Radiology, Children's Hospital of Philadelphia, and Department of Neurology, The Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA. ccampen@stanford.edu
authors.forename: Cynthia J
authors.initials: CJ
authors.lastname: Campen
authors.forename: Sarah M
authors.initials: SM
authors.lastname: Kranick
authors.forename: Scott E
authors.initials: SE
authors.lastname: Kasner
authors.forename: Sudha K
authors.initials: SK
authors.lastname: Kessler
authors.forename: Robert A
authors.initials: RA
authors.lastname: Zimmerman
authors.forename: Robert
authors.initials: R
authors.lastname: Lustig
authors.forename: Peter C
authors.initials: PC
authors.lastname: Phillips
authors.forename: Phillip B
authors.initials: PB
authors.lastname: Storm
authors.forename: Sabrina E
authors.initials: SE
authors.lastname: Smith
authors.forename: Rebecca
authors.initials: R
authors.lastname: Ichord
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Fisher
mesh_terms: D000293:Adolescent; D001932:Brain Neoplasms / Q000532:radiotherapy*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D016371:Cranial Irradiation / Q000009:adverse effects*; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D012189:Retrospective Studies; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology* / Q000209:etiology*; D017741:Survivors / Q000706:statistics & numerical data*; D055815:Young Adult