A Cross‐Sectional Cohort Study of Cerebrovascular Disease and Late Effects After Radiation Therapy for Craniopharyngioma. Issue 5 (12th January 2016)

• Record Type: Journal Article
• Authors: Lo, Andrea C.; Howard, A. Fuchsia; Nichol, Alan; Hasan, Haroon; Martin, Monty; Heran, Manraj; Goddard, Karen
• Is Part Of: Pediatric blood & cancer. Volume 63:Issue 5(2016:)
• Page Start: 786
• Page End: 793
• Publication Date: 2016-01-12
• Subjects: cerebrovascular accident -- craniopharyngioma -- late effects -- radiation therapy -- stroke; Tumors in children -- Periodicals; Blood -- Diseases -- Periodicals; Cancer in children -- Periodicals; 618.92
• DOI: 10.1002/pbc.25889
• Languages: English
• ISSNs: 1545-5009

Abstract

Abstract : Background: The study objective was to describe radiation‐induced vascular abnormalities, stroke prevalence, and stroke risk factors in survivors of childhood craniopharyngioma. Procedure: 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.