Childhood cancer survivors who have suffered a first stroke are more than twice as likely to experience a second stroke within 10 years compared to stroke survivors who have not had cancer, study findings indicate.

Risk factors for recurrent stroke were found to be similar to risk factors for a first stroke, and included high doses of cranial radiation therapy, cancer type, hypertension, and older age at the time of first stroke.

These findings are important in developing strategies for stroke prevention in this high-risk population. “If we could identify high-risk patients, we could recommend they be followed by a pediatric stroke specialist,” said study researcher Sabine Mueller, MD, PhD, director of the University of California San Francisco (UCSF) Pediatric Brain Tumor Center. “That will be huge in providing effective follow-up care for these children.”


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Mueller and colleagues performed a retrospective data analysis from the Childhood Cancer Survivor Study (CCSS), which included 14 358 childhood cancer survivors who were diagnosed from 1970 to 1986 and who were followed for an average of 23 years. They surveyed 443 survivors who reported a first stroke to identify recurrent stroke rates ≥5 years after cancer diagnosis. Overall, 329 patients completed the survey, 271 confirmed a first stroke at a median age of 19 years, and 70 reported a second stroke at a median age of 32 years.

The most common underlying cancer types were brain tumors (44%) and leukemia (28%), with the majority of patients having received cranial radiation; however, 22% had received neither cranial nor neck radiation.

The recurrent stroke rate for childhood cancer survivors was 21% in the 10 years after first ischemic stroke, nearly double the estimated 10% stroke recurrence rate in the general population, the researchers found.