title: A Cross-Sectional Cohort Study of Cerebrovascular Disease and Late Effects After Radiation Therapy for Craniopharyngioma.
abstract: BACKGROUND
  The study objective was to describe radiation-induced vascular abnormalities, stroke prevalence, and stroke risk factors in survivors of childhood craniopharyngioma.
  
  
  METHODS
  Twenty survivors of childhood craniopharyngioma who received radiotherapy (RT) were included in the study. A clinical history, quality of life assessment, cognitive functioning assessment, magnetic resonance angiogram or computed tomography angiogram, fasting lipid profile, and fasting glucose or hemoglobin A1c test were obtained.
  
  
  RESULTS
  Median age at diagnosis was 10.3 years and median age at time of study was 29.0 years. Vascular abnormalities were detected in six (32%) of 19 patients' angiograms (vascular stenosis, decreased artery size, aneurysm, cavernoma, and small vessel disease). Five (25%) of 20 patients experienced a stroke after RT. Median time since RT was 27.8 versus 9.1 years in patients with versus without vascular abnormalities (P = 0.02). A low level of high-density lipoproteiin (HDL) was present in 100% (5/5) of patients who had a post-RT stroke as compared with 13% (2/15) of patients who did not have any post-RT stroke (P = 0.02). Previous stroke had occurred in 0% (0/5) of patients receiving growth hormone (GH) replacement at the time of study, compared to 40% (6/15) of patients who were not receiving GH replacement (P = 0.09).
  
  
  CONCLUSIONS
  Patients with craniopharyngioma treated with RT have a high prevalence of stroke and vascular abnormalities, particularly those with low HDL and longer duration of time since RT. There is a trend to suggest that continual GH replacement may reduce the risk of stroke. These patients should undergo careful monitoring and aggressive modification of stroke risk factors.
authors.affiliation: Department of Radiation Oncology, British Columbia (BC) Cancer Agency Vancouver Centre, Vancouver, BC, Canada.|Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.
authors.forename: Andrea C
authors.initials: AC
authors.lastname: Lo
authors.affiliation: School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada.
authors.forename: A Fuchsia
authors.initials: AF
authors.lastname: Howard
authors.affiliation: Department of Radiation Oncology, British Columbia (BC) Cancer Agency Vancouver Centre, Vancouver, BC, Canada.|Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.
authors.forename: Alan
authors.initials: A
authors.lastname: Nichol
authors.affiliation: Department of Radiation Oncology, British Columbia (BC) Cancer Agency Vancouver Centre, Vancouver, BC, Canada.
authors.forename: Haroon
authors.initials: H
authors.lastname: Hasan
authors.affiliation: Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.|Department of Radiology, BC Cancer Agency Vancouver Centre, Vancouver, BC, Canada.
authors.forename: Monty
authors.initials: M
authors.lastname: Martin
authors.affiliation: Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.|Department of Radiology, Vancouver General Hospital, Vancouver, BC, Canada.
authors.forename: Manraj
authors.initials: M
authors.lastname: Heran
authors.affiliation: Department of Radiation Oncology, British Columbia (BC) Cancer Agency Vancouver Centre, Vancouver, BC, Canada.|Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.
authors.forename: Karen
authors.initials: K
authors.lastname: Goddard
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D002533:Cerebral Angiography; D002561:Cerebrovascular Disorders / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000209:etiology; D002648:Child; D002675:Child, Preschool; D003397:Craniopharyngioma / Q000532:radiotherapy*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D011832:Radiation Injuries / Q000000981:diagnostic imaging / Q000453:epidemiology; D011878:Radiotherapy / Q000009:adverse effects; D012307:Risk Factors
keywords: cerebrovascular accident; craniopharyngioma; late effects; radiation therapy; stroke