title: Recurrent stroke in childhood cancer survivors.
abstract: OBJECTIVE
  To estimate the rates and predictors of recurrent stroke among survivors of pediatric cancer who have had a first stroke.
  
  
  METHODS
  The Childhood Cancer Survivor Study is a retrospective cohort study with longitudinal follow-up that enrolled 14,358 survivors (<21 years old at diagnosis; diagnosed 1970-1986; survived ≥5 years after cancer diagnosis) and followed them prospectively since 1994. We surveyed 443 survivors who reported a first stroke to identify recurrent stroke, and estimated recurrent stroke rates ≥5 years after cancer diagnosis.
  
  
  RESULTS
  Among 329 respondents (74% response rate), 271 confirmed a first stroke at a median age of 19 years (range 0-53), and 70 reported a second stroke at a median age of 32 years (range 1-56). In a multivariable Cox proportional hazards model, independent predictors of recurrent stroke included cranial radiation therapy (CRT) dose of ≥50 Gy (vs none, hazard ratio [HR] 4.4; 95% confidence interval [CI] 1.4-13.7), hypertension (HR 1.9; 95% CI 1.0-3.5), and older age at first stroke (HR 6.4; 95% CI 1.8-23; for age ≥40 vs age 0-17 years). The 10-year cumulative incidence of late recurrent stroke was 21% (95% CI 16%-27%) overall, and 33% (95% CI 21%-44%) for those treated with ≥50 Gy of CRT.
  
  
  CONCLUSIONS
  Survivors of childhood cancer, particularly those previously treated with high-dose cranial radiation, have a high risk of recurrent stroke for decades after a first stroke. Although these strokes are mostly occurring in young adulthood, hypertension, an established atherosclerotic risk factor, independently predicts recurrent stroke in this population.
authors: From the Departments of Neurology (H.J.F., S.M.), Pediatrics (H.J.F., S.M., R.E.G.), and Neurosurgery (S.M.), University of California, San Francisco; the Fred Hutchinson Cancer Research Center (K.S., W.W.L.), Clinical Statistics and Cancer Prevention Programs, Seattle, WA; St. Jude Children's Research Hospital (G.T.A., L.L.R., K.R.K.), Memphis, TN; the University of Texas M.D. Anderson Cancer Center (R.E.W., M.S.), Houston; and Memorial Sloan-Kettering Cancer Center (C.A.S.), New York, NY.
authors: Heather J
authors: HJ
authors: Fullerton
authors: From the Departments of Neurology (H.J.F., S.M.), Pediatrics (H.J.F., S.M., R.E.G.), and Neurosurgery (S.M.), University of California, San Francisco; the Fred Hutchinson Cancer Research Center (K.S., W.W.L.), Clinical Statistics and Cancer Prevention Programs, Seattle, WA; St. Jude Children's Research Hospital (G.T.A., L.L.R., K.R.K.), Memphis, TN; the University of Texas M.D. Anderson Cancer Center (R.E.W., M.S.), Houston; and Memorial Sloan-Kettering Cancer Center (C.A.S.), New York, NY.
authors: Kayla
authors: K
authors: Stratton
authors: From the Departments of Neurology (H.J.F., S.M.), Pediatrics (H.J.F., S.M., R.E.G.), and Neurosurgery (S.M.), University of California, San Francisco; the Fred Hutchinson Cancer Research Center (K.S., W.W.L.), Clinical Statistics and Cancer Prevention Programs, Seattle, WA; St. Jude Children's Research Hospital (G.T.A., L.L.R., K.R.K.), Memphis, TN; the University of Texas M.D. Anderson Cancer Center (R.E.W., M.S.), Houston; and Memorial Sloan-Kettering Cancer Center (C.A.S.), New York, NY. muellers@neuropeds.ucsf.edu.
authors: Sabine
authors: S
authors: Mueller
authors: From the Departments of Neurology (H.J.F., S.M.), Pediatrics (H.J.F., S.M., R.E.G.), and Neurosurgery (S.M.), University of California, San Francisco; the Fred Hutchinson Cancer Research Center (K.S., W.W.L.), Clinical Statistics and Cancer Prevention Programs, Seattle, WA; St. Jude Children's Research Hospital (G.T.A., L.L.R., K.R.K.), Memphis, TN; the University of Texas M.D. Anderson Cancer Center (R.E.W., M.S.), Houston; and Memorial Sloan-Kettering Cancer Center (C.A.S.), New York, NY.
authors: Wendy W
authors: WW
authors: Leisenring
authors: From the Departments of Neurology (H.J.F., S.M.), Pediatrics (H.J.F., S.M., R.E.G.), and Neurosurgery (S.M.), University of California, San Francisco; the Fred Hutchinson Cancer Research Center (K.S., W.W.L.), Clinical Statistics and Cancer Prevention Programs, Seattle, WA; St. Jude Children's Research Hospital (G.T.A., L.L.R., K.R.K.), Memphis, TN; the University of Texas M.D. Anderson Cancer Center (R.E.W., M.S.), Houston; and Memorial Sloan-Kettering Cancer Center (C.A.S.), New York, NY.
authors: Greg T
authors: GT
authors: Armstrong
authors: From the Departments of Neurology (H.J.F., S.M.), Pediatrics (H.J.F., S.M., R.E.G.), and Neurosurgery (S.M.), University of California, San Francisco; the Fred Hutchinson Cancer Research Center (K.S., W.W.L.), Clinical Statistics and Cancer Prevention Programs, Seattle, WA; St. Jude Children's Research Hospital (G.T.A., L.L.R., K.R.K.), Memphis, TN; the University of Texas M.D. Anderson Cancer Center (R.E.W., M.S.), Houston; and Memorial Sloan-Kettering Cancer Center (C.A.S.), New York, NY.
authors: Rita E
authors: RE
authors: Weathers
authors: From the Departments of Neurology (H.J.F., S.M.), Pediatrics (H.J.F., S.M., R.E.G.), and Neurosurgery (S.M.), University of California, San Francisco; the Fred Hutchinson Cancer Research Center (K.S., W.W.L.), Clinical Statistics and Cancer Prevention Programs, Seattle, WA; St. Jude Children's Research Hospital (G.T.A., L.L.R., K.R.K.), Memphis, TN; the University of Texas M.D. Anderson Cancer Center (R.E.W., M.S.), Houston; and Memorial Sloan-Kettering Cancer Center (C.A.S.), New York, NY.
authors: Marilyn
authors: M
authors: Stovall
authors: From the Departments of Neurology (H.J.F., S.M.), Pediatrics (H.J.F., S.M., R.E.G.), and Neurosurgery (S.M.), University of California, San Francisco; the Fred Hutchinson Cancer Research Center (K.S., W.W.L.), Clinical Statistics and Cancer Prevention Programs, Seattle, WA; St. Jude Children's Research Hospital (G.T.A., L.L.R., K.R.K.), Memphis, TN; the University of Texas M.D. Anderson Cancer Center (R.E.W., M.S.), Houston; and Memorial Sloan-Kettering Cancer Center (C.A.S.), New York, NY.
authors: Charles A
authors: CA
authors: Sklar
authors: From the Departments of Neurology (H.J.F., S.M.), Pediatrics (H.J.F., S.M., R.E.G.), and Neurosurgery (S.M.), University of California, San Francisco; the Fred Hutchinson Cancer Research Center (K.S., W.W.L.), Clinical Statistics and Cancer Prevention Programs, Seattle, WA; St. Jude Children's Research Hospital (G.T.A., L.L.R., K.R.K.), Memphis, TN; the University of Texas M.D. Anderson Cancer Center (R.E.W., M.S.), Houston; and Memorial Sloan-Kettering Cancer Center (C.A.S.), New York, NY.
authors: Robert E
authors: RE
authors: Goldsby
authors: From the Departments of Neurology (H.J.F., S.M.), Pediatrics (H.J.F., S.M., R.E.G.), and Neurosurgery (S.M.), University of California, San Francisco; the Fred Hutchinson Cancer Research Center (K.S., W.W.L.), Clinical Statistics and Cancer Prevention Programs, Seattle, WA; St. Jude Children's Research Hospital (G.T.A., L.L.R., K.R.K.), Memphis, TN; the University of Texas M.D. Anderson Cancer Center (R.E.W., M.S.), Houston; and Memorial Sloan-Kettering Cancer Center (C.A.S.), New York, NY.
authors: Les L
authors: LL
authors: Robison
authors: From the Departments of Neurology (H.J.F., S.M.), Pediatrics (H.J.F., S.M., R.E.G.), and Neurosurgery (S.M.), University of California, San Francisco; the Fred Hutchinson Cancer Research Center (K.S., W.W.L.), Clinical Statistics and Cancer Prevention Programs, Seattle, WA; St. Jude Children's Research Hospital (G.T.A., L.L.R., K.R.K.), Memphis, TN; the University of Texas M.D. Anderson Cancer Center (R.E.W., M.S.), Houston; and Memorial Sloan-Kettering Cancer Center (C.A.S.), New York, NY.
authors: Kevin R
authors: KR
authors: Krull
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000175:diagnosis* / Q000453:epidemiology*; D012008:Recurrence; D012189:Retrospective Studies; D020521:Stroke / Q000175:diagnosis* / Q000453:epidemiology*; D017741:Survivors; D055815:Young Adult