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Published online before print October 7, 2009, doi:10.1212/WNL.0b013e3181c17ea8)
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NEUROLOGY 2009;73:1906-1913
© 2009 American Academy of Neurology
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Cerebrovascular disease in childhood cancer survivors

A Children’s Oncology Group Report B. Morris, MD, S. Partap, MD, K. Yeom, MD, I. C. Gibbs, MD, P. G. Fisher, MD and A. A. King, MD, MPH

From the Divisions of Neurology and Cancer Survivorship (B.M.), St. Jude Children’s Research Hospital, Memphis, TN; Departments of Neurology (S.P., P.G.F.), Radiology (K.Y.), Radiation Oncology (I.C.G.), and Pediatrics (P.G.F.), Stanford University School of Medicine, CA; and Program of Occupational Therapy and Department of Pediatrics (A.A.K.), Washington University School of Medicine and St. Louis Children’s Hospital, MO.

Address correspondence and reprint requests to Dr. E. Brannon Morris, 262 Danny Thomas Pl., MS 735, Memphis, TN 38105 brannon.morris{at}stjude.org

Background: Curative therapy for childhood cancer has dramatically improved over past decades. Therapeutic radiation has been instrumental in this success. Unfortunately, irradiation is associated with untoward effects, including stroke and other cerebrovascular disease (CVD). The Children’s Oncology Group (COG) has developed guidelines for screening survivors at risk for persistent or late sequelae of cancer therapy.

Objectives: This review summarizes the pathophysiology and relevant manifestations of radiation-induced CVD and outlines the specific patient groups at risk for early-onset stroke. The reader will be alerted to the availability of the COG recommendations for monitoring, and, when applicable, specific screening and treatment recommendations will be highlighted.

Methods: A multidisciplinary task force critically reviewed the existing literature and scored the evidence to establish the current COG guidelines for monitoring health of survivors treated with head and neck irradiation.

Results: Previous head and neck exposure to therapeutic radiation is associated with latent CVD and increased risk for stroke in some patient groups. Common manifestations of radiation-induced CVD includes steno-occlusive disease, moyamoya, aneurysm, mineralizing microangiopathy, vascular malformations, and strokelike migraines.

Conclusion: Risk for stroke is increased in survivors of pediatric CNS tumors, Hodgkin lymphoma, and acute lymphoblastic leukemia who received radiation to the brain and/or neck. As the population of survivors ages, vigilance for stroke and cerebrovascular disease needs to continue based on specific exposures during curative cancer therapy.

Abbreviations: ALL = acute lymphoblastic leukemia; CCSS = Childhood Cancer Survivor Study; CI = confidence interval; COG = Children’s Oncology Group; CVD = cerebrovascular disease; NF1 = neurofibromatosis type I; RT = radiation therapy.

Editorial, page 1816

Supplemental data at www.neurology.org

e-Pub ahead of print on October 7, 2009, at www.neurology.org.

*These authors contributed equally to this report.

This study was supported by Children’s Oncology Group Chairs’ Grant U10-CA98543.

Disclosure: Author disclosures are provided at the end of the article.

Received May 4, 2009. Accepted in final form August 20, 2009.


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Neurology 2009 73: 1816-1817. [Full Text] [PDF]



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L. C. Jordan and P. K. Duffner
Early-onset stroke and cerebrovascular disease in adult survivors of childhood cancer
Neurology, December 1, 2009; 73(22): 1816 - 1817.
[Full Text] [PDF]