Tiina Maria Remes1, Maria Helena Suo-Palosaari2, Päivi K T Koskenkorva3, Anna K Sutela3, Sanna-Maria Toiviainen-Salo4, Pekka M Arikoski5, Mikko O Arola6, Vesa-Pekka Heikkilä7, Mika Kapanen8, Päivi Maria Lähteenmäki9, Tuula R I Lönnqvist10, Hannele Niiniviita11, Tytti M-L Pokka1, Liisa Porra12, V Pekka Riikonen5, Jan Seppälä13, Kirsti H Sirkiä14, Antti Vanhanen8, Heikki M J Rantala1, Arja H Harila-Saari15, Marja K Ojaniemi1. 1. Department of Pediatrics and Adolescence, PEDEGO Research Unit and Medical Research Center, Oulu University Hospital, and University of Oulu, Oulu, Finland. 2. Department of Diagnostic Radiology, Oulu University Hospital, and University of Oulu, Research Unit of Medical Imaging, Physics, and Technology, Faculty of Medicine, University of Oulu, and Medical Research Center Oulu, University of Oulu, Oulu, Finland. 3. Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland. 4. Department of Pediatric Radiology, HUS Medical Imaging Center, Radiology, University of Helsinki, and Helsinki University Hospital, Helsinki, Finland. 5. Department of Pediatrics and Adolescence, Kuopio University Hospital, University of Eastern Finland, Kuopio, Finland. 6. Department of Pediatrics, Tampere University Hospital, and University of Tampere, Tampere, Finland. 7. Department of Oncology and Radiotherapy, Oulu University Hospital, Oulu, Finland. 8. Department of Oncology and Department of Medical Physics, Tampere University Hospital, Tampere, Finland. 9. Department of Pediatrics and Adolescent Medicine, Turku University Hospital, and Turku University, Turku, Finland. 10. Department of Child Neurology, Children's Hospital, University of Helsinki, and Helsinki University Hospital, Helsinki, Finland. 11. Department of Medical Physics, Division of Medical Imaging, Turku University Hospital, Turku, Finland. 12. Department of Oncology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland. 13. Center of Oncology, Kuopio University Hospital, Kuopio, Finland. 14. Department of Pediatrics and Adolescence, Helsinki University, and Helsinki University Hospital, Helsinki, Finland. 15. Uppsala University, Department of Women's and Children's Health, Akademiska sjukhuset, Uppsala, Sweden.
Abstract
BACKGROUND: Cranial radiotherapy may damage the cerebral vasculature. The aim of this study was to understand the prevalence and risk factors of cerebrovascular disease (CVD) and white matter hyperintensities (WMHs) in childhood brain tumors (CBT) survivors treated with radiotherapy. METHODS: Seventy CBT survivors who received radiotherapy were enrolled in a cross-sectional study at a median 20 years after radiotherapy cessation. The prevalence of and risk factors for CVD were investigated using MRI, MRA, and laboratory testing. Tumors, their treatment, and stroke-related data were retrieved from patients' files. RESULTS: Forty-four individuals (63%) had CVD at a median age of 27 years (range, 16-43 years). The prevalence rates at 20 years for CVD, small-vessel disease, and large-vessel disease were 52%, 38%, and 16%, respectively. Ischemic infarcts were diagnosed in 6 survivors, and cerebral hemorrhage in 2. Lacunar infarcts were present in 7, periventricular or deep WMHs in 34 (49%), and mineralizing microangiopathy in 21 (30%) survivors. Multiple pathologies were detected in 44% of the participants, and most lesions were located in a high-dose radiation area. Higher blood pressure was associated with CVD and a presence of WMHs. Higher cholesterol levels increased the risk of ischemic infarcts and WMHs, and lower levels of high-density lipoprotein and higher waist circumference increased the risk of lacunar infarcts. CONCLUSIONS: Treating CBTs with radiotherapy increases the risk of early CVD and WMHs in young adult survivors. These results suggest an urgent need for investigating CVD prevention in CBT patients.
BACKGROUND: Cranial radiotherapy may damage the cerebral vasculature. The aim of this study was to understand the prevalence and risk factors of cerebrovascular disease (CVD) and white matter hyperintensities (WMHs) in childhood brain tumors (CBT) survivors treated with radiotherapy. METHODS: Seventy CBT survivors who received radiotherapy were enrolled in a cross-sectional study at a median 20 years after radiotherapy cessation. The prevalence of and risk factors for CVD were investigated using MRI, MRA, and laboratory testing. Tumors, their treatment, and stroke-related data were retrieved from patients' files. RESULTS: Forty-four individuals (63%) had CVD at a median age of 27 years (range, 16-43 years). The prevalence rates at 20 years for CVD, small-vessel disease, and large-vessel disease were 52%, 38%, and 16%, respectively. Ischemic infarcts were diagnosed in 6 survivors, and cerebral hemorrhage in 2. Lacunar infarcts were present in 7, periventricular or deep WMHs in 34 (49%), and mineralizing microangiopathy in 21 (30%) survivors. Multiple pathologies were detected in 44% of the participants, and most lesions were located in a high-dose radiation area. Higher blood pressure was associated with CVD and a presence of WMHs. Higher cholesterol levels increased the risk of ischemic infarcts and WMHs, and lower levels of high-density lipoprotein and higher waist circumference increased the risk of lacunar infarcts. CONCLUSIONS: Treating CBTs with radiotherapy increases the risk of early CVD and WMHs in young adult survivors. These results suggest an urgent need for investigating CVD prevention in CBT patients.
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Authors: Julia Anttonen; Tiina Remes; Pekka Arikoski; Päivi Lähteenmäki; Mikko Arola; Arja Harila-Saari; Tuula Lönnqvist; Tytti Pokka; Pekka Riikonen; Kirsti Sirkiä; Heikki Rantala; Marja Ojaniemi Journal: PLoS One Date: 2022-09-06 Impact factor: 3.752