Abstract
Survivors of childhood cancer treated with cranial irradiation are at risk of cerebrovascular disease (CVD), but the risks beyond age 50 are unknown. In all, 13457 survivors of childhood cancer included in the population-based British Childhood Cancer Survivor Study cohort were linked to Hospital Episode Statistics data for England. Risk of CVD related hospitalisation was quantified by standardised hospitalisation ratios (SHRs), absolute excess risks and cumulative incidence. Overall, 315 (2.3%) survivors had been hospitalised at least once for CVD with a 4-fold risk compared to that expected (95% confidence interval [CI]: 3.7-4.3). Survivors of a central nervous system (CNS) tumour and leukaemia treated with cranial irradiation were at greatest risk of CVD (SHR = 15.6, 95% CI: 14.0-17.4; SHR = 5.4; 95% CI: 4.5-6.5, respectively). Beyond age 60, on average, 3.1% of CNS tumour survivors treated with cranial irradiation were hospitalised annually for CVD (0.4% general population). Cumulative incidence of CVD increased from 16.0% at age 50 to 26.0% at age 65 (general population: 1.4-4.2%). In conclusion, among CNS tumour survivors treated with cranial irradiation, the risk of CVD continues to increase substantially beyond age 50 up to at least age 65. Such survivors should be: counselled regarding this risk; regularly monitored for hypertension, dyslipidaemia and diabetes; advised on life-style risk behaviours. Future research should include the recall for counselling and brain MRI to identify subgroups that could benefit from pharmacological or surgical intervention and establishment of a case-control study to comprehensively determine risk-factors for CVD.
Highlights
Survival after childhood cancer has markedly improved over the last few decades with overall 5-year survival in the United Kingdom exceeding 80%.1 the number of long-term survivors continues to increase, many subgroups of survivors are at risk of developing adverse health conditions many years after treatment.[2,3] Circulatory conditions, including cerebrovascular disease (CVD), are the leading cause of death among ageing survivors.[4]
Among central nervous system (CNS) tumour survivors treated with cranial irradiation the cumulative incidence of CVD was 11.6% by age 40, increased to 16.0% by age 50 and reached 26.0% by age 65, whilst only 4.2% was expected by age 65 (Figure 2)
The cumulative incidence figures from these studies are consistent with the 13.4% and 16.0% cumulative incidence at age 45 and 50, respectively, for survivors of a CNS tumour treated with cranial irradiation we report here
Summary
Survival after childhood cancer has markedly improved over the last few decades with overall 5-year survival in the United Kingdom exceeding 80%.1 the number of long-term survivors continues to increase, many subgroups of survivors are at risk of developing adverse health conditions many years after treatment.[2,3] Circulatory conditions, including cerebrovascular disease (CVD), are the leading cause of death among ageing survivors.[4]. If the relative risk (RR) remains elevated into ages at which the risk of developing CVD in the general population starts to increase substantially, a considerable number of survivors could be affected. To our knowledge, this is the first large-scale study to quantify the risks of CVD up to age 65 according to whether survivors were treated with cranial radiotherapy or not
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