21 results on '"Sklar, Charles A."'
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2. Hypothalamic-Pituitary Disorders in Childhood Cancer Survivors : Prevalence, Risk Factors and Long-Term Health Outcomes
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van Iersel, Laura, Li, Zhenghong, Srivastava, Deo Kumar, Brinkman, Tara M., Bjornard, Kari L., Wilson, Carmen L., Green, Daniel M., Merchant, Thomas E., Pui, Ching Hon, Howell, Rebecca M., Smith, Susan A., Armstrong, Gregory T., Hudson, Melissa M., Robison, Leslie L., Ness, Kirsten K., Gajjar, Amar, Krull, Kevin R., Sklar, Charles A., van Santen, Hanneke M., Chemaitilly, Wassim, van Iersel, Laura, Li, Zhenghong, Srivastava, Deo Kumar, Brinkman, Tara M., Bjornard, Kari L., Wilson, Carmen L., Green, Daniel M., Merchant, Thomas E., Pui, Ching Hon, Howell, Rebecca M., Smith, Susan A., Armstrong, Gregory T., Hudson, Melissa M., Robison, Leslie L., Ness, Kirsten K., Gajjar, Amar, Krull, Kevin R., Sklar, Charles A., van Santen, Hanneke M., and Chemaitilly, Wassim
- Published
- 2019
3. Leydig Cell Function in Male Survivors of Childhood Cancer : A Report From the St Jude Lifetime Cohort Study
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Chemaitilly, Wassim, Liu, Qi, van Iersel, Laura, Ness, Kirsten K., Li, Zhenghong, Wilson, Carmen L., Brinkman, Tara M., Klosky, James L., Barnes, Nicole, Clark, Karen L., Howell, Rebecca M., Smith, Susan A., Krasin, Matthew J., Metzger, Monika L., Armstrong, Gregory T., Bishop, Michael W., van Santen, Hanneke M., Pui, Ching Hon, Srivastava, Deo Kumar, Yasui, Yutaka, Hudson, Melissa M., Robison, Leslie L., Green, Daniel M., Sklar, Charles A., Chemaitilly, Wassim, Liu, Qi, van Iersel, Laura, Ness, Kirsten K., Li, Zhenghong, Wilson, Carmen L., Brinkman, Tara M., Klosky, James L., Barnes, Nicole, Clark, Karen L., Howell, Rebecca M., Smith, Susan A., Krasin, Matthew J., Metzger, Monika L., Armstrong, Gregory T., Bishop, Michael W., van Santen, Hanneke M., Pui, Ching Hon, Srivastava, Deo Kumar, Yasui, Yutaka, Hudson, Melissa M., Robison, Leslie L., Green, Daniel M., and Sklar, Charles A.
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- 2019
4. Hypothalamic-Pituitary Disorders in Childhood Cancer Survivors : Prevalence, Risk Factors and Long-Term Health Outcomes
- Author
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van Iersel, Laura, Li, Zhenghong, Srivastava, Deo Kumar, Brinkman, Tara M., Bjornard, Kari L., Wilson, Carmen L., Green, Daniel M., Merchant, Thomas E., Pui, Ching Hon, Howell, Rebecca M., Smith, Susan A., Armstrong, Gregory T., Hudson, Melissa M., Robison, Leslie L., Ness, Kirsten K., Gajjar, Amar, Krull, Kevin R., Sklar, Charles A., van Santen, Hanneke M., Chemaitilly, Wassim, van Iersel, Laura, Li, Zhenghong, Srivastava, Deo Kumar, Brinkman, Tara M., Bjornard, Kari L., Wilson, Carmen L., Green, Daniel M., Merchant, Thomas E., Pui, Ching Hon, Howell, Rebecca M., Smith, Susan A., Armstrong, Gregory T., Hudson, Melissa M., Robison, Leslie L., Ness, Kirsten K., Gajjar, Amar, Krull, Kevin R., Sklar, Charles A., van Santen, Hanneke M., and Chemaitilly, Wassim
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- 2019
5. Hypothalamic-Pituitary Disorders in Childhood Cancer Survivors : Prevalence, Risk Factors and Long-Term Health Outcomes
- Author
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van Iersel, Laura, Li, Zhenghong, Srivastava, Deo Kumar, Brinkman, Tara M., Bjornard, Kari L., Wilson, Carmen L., Green, Daniel M., Merchant, Thomas E., Pui, Ching Hon, Howell, Rebecca M., Smith, Susan A., Armstrong, Gregory T., Hudson, Melissa M., Robison, Leslie L., Ness, Kirsten K., Gajjar, Amar, Krull, Kevin R., Sklar, Charles A., van Santen, Hanneke M., Chemaitilly, Wassim, van Iersel, Laura, Li, Zhenghong, Srivastava, Deo Kumar, Brinkman, Tara M., Bjornard, Kari L., Wilson, Carmen L., Green, Daniel M., Merchant, Thomas E., Pui, Ching Hon, Howell, Rebecca M., Smith, Susan A., Armstrong, Gregory T., Hudson, Melissa M., Robison, Leslie L., Ness, Kirsten K., Gajjar, Amar, Krull, Kevin R., Sklar, Charles A., van Santen, Hanneke M., and Chemaitilly, Wassim
- Published
- 2019
6. Leydig Cell Function in Male Survivors of Childhood Cancer : A Report From the St Jude Lifetime Cohort Study
- Author
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Chemaitilly, Wassim, Liu, Qi, van Iersel, Laura, Ness, Kirsten K., Li, Zhenghong, Wilson, Carmen L., Brinkman, Tara M., Klosky, James L., Barnes, Nicole, Clark, Karen L., Howell, Rebecca M., Smith, Susan A., Krasin, Matthew J., Metzger, Monika L., Armstrong, Gregory T., Bishop, Michael W., van Santen, Hanneke M., Pui, Ching Hon, Srivastava, Deo Kumar, Yasui, Yutaka, Hudson, Melissa M., Robison, Leslie L., Green, Daniel M., Sklar, Charles A., Chemaitilly, Wassim, Liu, Qi, van Iersel, Laura, Ness, Kirsten K., Li, Zhenghong, Wilson, Carmen L., Brinkman, Tara M., Klosky, James L., Barnes, Nicole, Clark, Karen L., Howell, Rebecca M., Smith, Susan A., Krasin, Matthew J., Metzger, Monika L., Armstrong, Gregory T., Bishop, Michael W., van Santen, Hanneke M., Pui, Ching Hon, Srivastava, Deo Kumar, Yasui, Yutaka, Hudson, Melissa M., Robison, Leslie L., Green, Daniel M., and Sklar, Charles A.
- Published
- 2019
7. Hypothalamic-Pituitary Disorders in Childhood Cancer Survivors: Prevalence, Risk Factors and Long-Term Health Outcomes
- Author
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Child Health, Endocrinologie patientenzorg, van Iersel, Laura, Li, Zhenghong, Srivastava, Deo Kumar, Brinkman, Tara M., Bjornard, Kari L., Wilson, Carmen L., Green, Daniel M., Merchant, Thomas E., Pui, Ching Hon, Howell, Rebecca M., Smith, Susan A., Armstrong, Gregory T., Hudson, Melissa M., Robison, Leslie L., Ness, Kirsten K., Gajjar, Amar, Krull, Kevin R., Sklar, Charles A., van Santen, Hanneke M., Chemaitilly, Wassim, Child Health, Endocrinologie patientenzorg, van Iersel, Laura, Li, Zhenghong, Srivastava, Deo Kumar, Brinkman, Tara M., Bjornard, Kari L., Wilson, Carmen L., Green, Daniel M., Merchant, Thomas E., Pui, Ching Hon, Howell, Rebecca M., Smith, Susan A., Armstrong, Gregory T., Hudson, Melissa M., Robison, Leslie L., Ness, Kirsten K., Gajjar, Amar, Krull, Kevin R., Sklar, Charles A., van Santen, Hanneke M., and Chemaitilly, Wassim
- Published
- 2019
8. Leydig Cell Function in Male Survivors of Childhood Cancer: A Report From the St Jude Lifetime Cohort Study
- Author
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Child Health, Endocrinologie patientenzorg, Chemaitilly, Wassim, Liu, Qi, van Iersel, Laura, Ness, Kirsten K., Li, Zhenghong, Wilson, Carmen L., Brinkman, Tara M., Klosky, James L., Barnes, Nicole, Clark, Karen L., Howell, Rebecca M., Smith, Susan A., Krasin, Matthew J., Metzger, Monika L., Armstrong, Gregory T., Bishop, Michael W., van Santen, Hanneke M., Pui, Ching Hon, Srivastava, Deo Kumar, Yasui, Yutaka, Hudson, Melissa M., Robison, Leslie L., Green, Daniel M., Sklar, Charles A., Child Health, Endocrinologie patientenzorg, Chemaitilly, Wassim, Liu, Qi, van Iersel, Laura, Ness, Kirsten K., Li, Zhenghong, Wilson, Carmen L., Brinkman, Tara M., Klosky, James L., Barnes, Nicole, Clark, Karen L., Howell, Rebecca M., Smith, Susan A., Krasin, Matthew J., Metzger, Monika L., Armstrong, Gregory T., Bishop, Michael W., van Santen, Hanneke M., Pui, Ching Hon, Srivastava, Deo Kumar, Yasui, Yutaka, Hudson, Melissa M., Robison, Leslie L., Green, Daniel M., and Sklar, Charles A.
- Published
- 2019
9. Endocrine late effects in childhood cancer survivors
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Chemaitilly, Wassim, Cohen, Laurie E., Mostoufi-Moab, Sogol, Patterson, Briana C., Simmons, Jill H., Meacham, Lillian R., van Santen, Hanneke M., Sklar, Charles A., Chemaitilly, Wassim, Cohen, Laurie E., Mostoufi-Moab, Sogol, Patterson, Briana C., Simmons, Jill H., Meacham, Lillian R., van Santen, Hanneke M., and Sklar, Charles A.
- Published
- 2018
10. Endocrine late effects in childhood cancer survivors
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Chemaitilly, Wassim, Cohen, Laurie E., Mostoufi-Moab, Sogol, Patterson, Briana C., Simmons, Jill H., Meacham, Lillian R., van Santen, Hanneke M., Sklar, Charles A., Chemaitilly, Wassim, Cohen, Laurie E., Mostoufi-Moab, Sogol, Patterson, Briana C., Simmons, Jill H., Meacham, Lillian R., van Santen, Hanneke M., and Sklar, Charles A.
- Published
- 2018
11. Endocrine late effects in childhood cancer survivors
- Author
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Chemaitilly, Wassim, Cohen, Laurie E., Mostoufi-Moab, Sogol, Patterson, Briana C., Simmons, Jill H., Meacham, Lillian R., van Santen, Hanneke M., Sklar, Charles A., Chemaitilly, Wassim, Cohen, Laurie E., Mostoufi-Moab, Sogol, Patterson, Briana C., Simmons, Jill H., Meacham, Lillian R., van Santen, Hanneke M., and Sklar, Charles A.
- Published
- 2018
12. Long-term sequelae in survivors of childhood leukemia with Down syndrome: A childhood cancer survivor study report.
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Goldsby, Robert E, Goldsby, Robert E, Stratton, Kayla L, Raber, Shannon, Ablin, Arthur, Strong, Louise C, Oeffinger, Kevin, Sklar, Charles A, Armstrong, Gregory T, Robison, Leslie L, Bhatia, Smita, Leisenring, Wendy M, Goldsby, Robert E, Goldsby, Robert E, Stratton, Kayla L, Raber, Shannon, Ablin, Arthur, Strong, Louise C, Oeffinger, Kevin, Sklar, Charles A, Armstrong, Gregory T, Robison, Leslie L, Bhatia, Smita, and Leisenring, Wendy M
- Abstract
BackgroundChildren with Down syndrome (DS) are at increased risk of developing acute leukemia and are more prone to acute toxicities. We studied the incidence and severity of chronic health conditions among survivors of childhood leukemia with DS compared with those without DS.MethodsChronic health conditions reported by questionnaire were compared between 154 pediatric leukemia survivors with DS and 581 without DS, matched by leukemia, age at diagnosis, race/ethnicity, sex, radiation location and chemotherapy exposure using Cox models to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). Subjects were selected from 7139 5-year survivors of leukemia in the Childhood Cancer Survivor Study.ResultsRisk of at least 1 late onset chronic health condition (grade 1-5) was similar in the DS population compared with the non-DS group (HR, 1.1; 95% CI, 0.7-1.5). Serious chronic health conditions (grade 3-5) were more common in DS survivors (HR, 1.7; 95% CI, 1.1-2.6), as were ≥ 3 chronic health conditions (grades 1-5) (HR, 1.7; 95% CI, 1.2-2.4). The 25-year cumulative incidence of any condition (grades 1-5) was 83% for DS survivors and 69% for non-DS survivors.ConclusionLeukemia survivors with DS have therapy-related chronic health conditions comparable to those of similarly treated survivors without DS, with a few notable exceptions: 1) an increased risk of cataracts, hearing loss, and thyroid dysfunction compared with survivors without DS (though these are known risks in the DS population), 2) decreased risk of second cancers, and 3) increased risk of severe or multiple conditions. Practitioners should be aware of these risks during and after therapy. Cancer 2018;124:617-25. © 2017 American Cancer Society.
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- 2018
13. Endocrine late effects in childhood cancer survivors
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Endocrinologie patientenzorg, Child Health, Chemaitilly, Wassim, Cohen, Laurie E., Mostoufi-Moab, Sogol, Patterson, Briana C., Simmons, Jill H., Meacham, Lillian R., van Santen, Hanneke M., Sklar, Charles A., Endocrinologie patientenzorg, Child Health, Chemaitilly, Wassim, Cohen, Laurie E., Mostoufi-Moab, Sogol, Patterson, Briana C., Simmons, Jill H., Meacham, Lillian R., van Santen, Hanneke M., and Sklar, Charles A.
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- 2018
14. Longitudinal follow-up of adult survivors of Ewing sarcoma: A report from the Childhood Cancer Survivor Study.
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Marina, Neyssa M, Marina, Neyssa M, Liu, Qi, Donaldson, Sarah S, Sklar, Charles A, Armstrong, Gregory T, Oeffinger, Kevin C, Leisenring, Wendy M, Ginsberg, Jill P, Henderson, Tara O, Neglia, Joseph P, Stovall, Marilyn A, Yasui, Yutaka, Randall, R Lor, Geller, David S, Robison, Leslie L, Ness, Kirsten K, Marina, Neyssa M, Marina, Neyssa M, Liu, Qi, Donaldson, Sarah S, Sklar, Charles A, Armstrong, Gregory T, Oeffinger, Kevin C, Leisenring, Wendy M, Ginsberg, Jill P, Henderson, Tara O, Neglia, Joseph P, Stovall, Marilyn A, Yasui, Yutaka, Randall, R Lor, Geller, David S, Robison, Leslie L, and Ness, Kirsten K
- Abstract
BackgroundEwing sarcoma survivors (ESSs) are at increased risk for treatment-related complications. The incidence of treatment-related morbidity and late mortality with aging is unknown.MethodsThis study reports survival probabilities, estimated with the Kaplan-Meier method, and the cumulative incidence of cause-specific mortality and chronic conditions among ESSs in the Childhood Cancer Survivor Study who were treated between 1970 and 1986. Piecewise exponential models were used to estimate relative rates (RRs) and 95% confidence intervals (CIs) for these outcomes. Chronic conditions were graded with the Common Terminology Criteria for Adverse Events (version 4.03).ResultsAmong 404 5-year ESSs (median age at last follow-up, 34.8 years; range, 9.1-54.8 years), the 35-year survival rate was 70% (95% CI, 66%-74%). Late recurrence (cumulative incidence at 35 years, 15.1%) was the most common cause of death, and it was followed by treatment-related causes (11.2%). There were 53 patients with subsequent neoplasms (SNs; cumulative incidence at 35 years, 24.0%), and 38 were malignant (14.3% at 35 years). The standardized incidence ratios were 377.1 (95% CI, 172.1-715.9) for osteosarcoma, 28.9 (95% CI, 3.2-104.2) for acute myeloid leukemia, 14.9 (95% CI, 7.9-25.5) for breast cancer, and 13.1 (95% CI, 4.8-28.5) for thyroid cancer. Rates of chronic conditions were highest for musculoskeletal (RR, 18.1; 95% CI, 12.8-25.7) and cardiac complications (RR, 1.8; 95% CI, 1.4-2.3). Thirty-five years after the diagnosis, the cumulative incidences of any chronic conditions and 2 or more chronic conditions were 84.6% (95% CI, 80.4%-88.8%) and 73.8% (95% CI, 67.8%-79.9%), respectively.ConclusionsWith extended follow-up, ESSs' risk for late mortality and SNs does not plateau. Treatment-related chronic conditions develop years after therapy, and this supports the need for lifelong follow-up. Cancer 2017;123:2551-60. © 2017 American Cancer Society.
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- 2017
15. Recurrent stroke in childhood cancer survivors.
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Fullerton, Heather J, Fullerton, Heather J, Stratton, Kayla, Mueller, Sabine, Leisenring, Wendy W, Armstrong, Greg T, Weathers, Rita E, Stovall, Marilyn, Sklar, Charles A, Goldsby, Robert E, Robison, Les L, Krull, Kevin R, Fullerton, Heather J, Fullerton, Heather J, Stratton, Kayla, Mueller, Sabine, Leisenring, Wendy W, Armstrong, Greg T, Weathers, Rita E, Stovall, Marilyn, Sklar, Charles A, Goldsby, Robert E, Robison, Les L, and Krull, Kevin R
- Abstract
ObjectiveTo estimate the rates and predictors of recurrent stroke among survivors of pediatric cancer who have had a first stroke.MethodsThe Childhood Cancer Survivor Study is a retrospective cohort study with longitudinal follow-up that enrolled 14,358 survivors (<21 years old at diagnosis; diagnosed 1970-1986; survived ≥5 years after cancer diagnosis) and followed them prospectively since 1994. We surveyed 443 survivors who reported a first stroke to identify recurrent stroke, and estimated recurrent stroke rates ≥5 years after cancer diagnosis.ResultsAmong 329 respondents (74% response rate), 271 confirmed a first stroke at a median age of 19 years (range 0-53), and 70 reported a second stroke at a median age of 32 years (range 1-56). In a multivariable Cox proportional hazards model, independent predictors of recurrent stroke included cranial radiation therapy (CRT) dose of ≥50 Gy (vs none, hazard ratio [HR] 4.4; 95% confidence interval [CI] 1.4-13.7), hypertension (HR 1.9; 95% CI 1.0-3.5), and older age at first stroke (HR 6.4; 95% CI 1.8-23; for age ≥40 vs age 0-17 years). The 10-year cumulative incidence of late recurrent stroke was 21% (95% CI 16%-27%) overall, and 33% (95% CI 21%-44%) for those treated with ≥50 Gy of CRT.ConclusionSurvivors of childhood cancer, particularly those previously treated with high-dose cranial radiation, have a high risk of recurrent stroke for decades after a first stroke. Although these strokes are mostly occurring in young adulthood, hypertension, an established atherosclerotic risk factor, independently predicts recurrent stroke in this population.
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- 2015
16. Recurrent stroke in childhood cancer survivors.
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Fullerton, Heather J, Fullerton, Heather J, Stratton, Kayla, Mueller, Sabine, Leisenring, Wendy W, Armstrong, Greg T, Weathers, Rita E, Stovall, Marilyn, Sklar, Charles A, Goldsby, Robert E, Robison, Les L, Krull, Kevin R, Fullerton, Heather J, Fullerton, Heather J, Stratton, Kayla, Mueller, Sabine, Leisenring, Wendy W, Armstrong, Greg T, Weathers, Rita E, Stovall, Marilyn, Sklar, Charles A, Goldsby, Robert E, Robison, Les L, and Krull, Kevin R
- Abstract
ObjectiveTo estimate the rates and predictors of recurrent stroke among survivors of pediatric cancer who have had a first stroke.MethodsThe Childhood Cancer Survivor Study is a retrospective cohort study with longitudinal follow-up that enrolled 14,358 survivors (<21 years old at diagnosis; diagnosed 1970-1986; survived ≥5 years after cancer diagnosis) and followed them prospectively since 1994. We surveyed 443 survivors who reported a first stroke to identify recurrent stroke, and estimated recurrent stroke rates ≥5 years after cancer diagnosis.ResultsAmong 329 respondents (74% response rate), 271 confirmed a first stroke at a median age of 19 years (range 0-53), and 70 reported a second stroke at a median age of 32 years (range 1-56). In a multivariable Cox proportional hazards model, independent predictors of recurrent stroke included cranial radiation therapy (CRT) dose of ≥50 Gy (vs none, hazard ratio [HR] 4.4; 95% confidence interval [CI] 1.4-13.7), hypertension (HR 1.9; 95% CI 1.0-3.5), and older age at first stroke (HR 6.4; 95% CI 1.8-23; for age ≥40 vs age 0-17 years). The 10-year cumulative incidence of late recurrent stroke was 21% (95% CI 16%-27%) overall, and 33% (95% CI 21%-44%) for those treated with ≥50 Gy of CRT.ConclusionSurvivors of childhood cancer, particularly those previously treated with high-dose cranial radiation, have a high risk of recurrent stroke for decades after a first stroke. Although these strokes are mostly occurring in young adulthood, hypertension, an established atherosclerotic risk factor, independently predicts recurrent stroke in this population.
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- 2015
17. Intestinal Obstruction in Survivors of Childhood Cancer: A Report From the Childhood Cancer Survivor Study.
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Madenci, Arin L, Madenci, Arin L, Fisher, Stacey, Diller, Lisa R, Goldsby, Robert E, Leisenring, Wendy M, Oeffinger, Kevin C, Robison, Leslie L, Sklar, Charles A, Stovall, Marilyn, Weathers, Rita E, Armstrong, Gregory T, Yasui, Yutaka, Weldon, Christopher B, Madenci, Arin L, Madenci, Arin L, Fisher, Stacey, Diller, Lisa R, Goldsby, Robert E, Leisenring, Wendy M, Oeffinger, Kevin C, Robison, Leslie L, Sklar, Charles A, Stovall, Marilyn, Weathers, Rita E, Armstrong, Gregory T, Yasui, Yutaka, and Weldon, Christopher B
- Abstract
PurposeFor adult survivors of childhood cancer, knowledge about the long-term risk of intestinal obstruction from surgery, chemotherapy, and radiotherapy is limited.MethodsIntestinal obstruction requiring surgery (IOS) occurring 5 or more years after cancer diagnosis was evaluated in 12,316 5-year survivors in the Childhood Cancer Survivor Study (2,002 with and 10,314 without abdominopelvic tumors) and 4,023 sibling participants. Cumulative incidence of IOS was calculated with second malignant neoplasm, late recurrence, and death as competing risks. Using piecewise exponential models, we assessed the associations of clinical and demographic factors with rate of IOS.ResultsLate IOS was reported by 165 survivors (median age at IOS, 19 years; range, 5 to 50 years; median time from diagnosis to IOS, 13 years) and 14 siblings. The cumulative incidence of late IOS at 35 years was 5.8% (95% CI, 4.4% to 7.3%) among survivors with abdominopelvic tumors, 1.0% (95% CI, 0.7% to 1.4%) among those without abdominopelvic tumors, and 0.3% (95% CI, 0.1% to 0.5%) among siblings. Among survivors, abdominopelvic tumor (adjusted rate ratio [ARR], 3.6; 95% CI, 1.9 to 6.8; P < .001) and abdominal/pelvic radiotherapy within 5 years of cancer diagnosis (ARR, 2.4; 95% CI, 1.6 to 3.7; P < .001) increased the rate of late IOS, adjusting for diagnosis year; sex; race/ethnicity; age at diagnosis; age during follow-up (as natural cubic spline); cancer type; and chemotherapy, radiotherapy, and surgery within 5 years of cancer diagnosis. Developing late IOS increased subsequent mortality among survivors (ARR, 1.8; 95% CI, 1.1 to 2.9; P = .016), adjusting for the same factors.ConclusionThe long-term risk of IOS and its association with subsequent mortality underscore the need to promote awareness of this complication among patients and providers.
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- 2015
18. Radiation, atherosclerotic risk factors, and stroke risk in survivors of pediatric cancer: a report from the Childhood Cancer Survivor Study.
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Mueller, Sabine, Mueller, Sabine, Fullerton, Heather J, Stratton, Kayla, Leisenring, Wendy, Weathers, Rita E, Stovall, Marilyn, Armstrong, Gregory T, Goldsby, Robert E, Packer, Roger J, Sklar, Charles A, Bowers, Daniel C, Robison, Leslie L, Krull, Kevin R, Mueller, Sabine, Mueller, Sabine, Fullerton, Heather J, Stratton, Kayla, Leisenring, Wendy, Weathers, Rita E, Stovall, Marilyn, Armstrong, Gregory T, Goldsby, Robert E, Packer, Roger J, Sklar, Charles A, Bowers, Daniel C, Robison, Leslie L, and Krull, Kevin R
- Abstract
PurposeTo test the hypotheses that (1) the increased risk of stroke conferred by childhood cranial radiation therapy (CRT) persists into adulthood; and (2) atherosclerotic risk factors further increase the stroke risk in cancer survivors.Methods and materialsThe Childhood Cancer Survivor Study is a multi-institutional retrospective cohort study of 14,358 5-year survivors of childhood cancer and 4023 randomly selected sibling controls with longitudinal follow-up. Age-adjusted incidence rates of self-reported late-occurring (≥5 years after diagnosis) first stroke were calculated. Multivariable Cox proportional hazards models were used to identify independent stroke predictors.ResultsDuring a mean follow-up of 23.3 years, 292 survivors reported a late-occurring stroke. The age-adjusted stroke rate per 100,000 person-years was 77 (95% confidence interval [CI] 62-96), compared with 9.3 (95% CI 4-23) for siblings. Treatment with CRT increased stroke risk in a dose-dependent manner: hazard ratio 5.9 (95% CI 3.5-9.9) for 30-49 Gy CRT and 11.0 (7.4-17.0) for 50+ Gy CRT. The cumulative stroke incidence in survivors treated with 50+ Gy CRT was 1.1% (95% CI 0.4-1.8%) at 10 years after diagnosis and 12% (95% CI 8.9-15.0%) at 30 years. Hypertension increased stroke hazard by 4-fold (95% CI 2.8-5.5) and in black survivors by 16-fold (95% CI 6.9-36.6).ConclusionYoung adult pediatric cancer survivors have an increased stroke risk that is associated with CRT in a dose-dependent manner. Atherosclerotic risk factors enhanced this risk and should be treated aggressively.
- Published
- 2013
19. Radiation, atherosclerotic risk factors, and stroke risk in survivors of pediatric cancer: a report from the Childhood Cancer Survivor Study.
- Author
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Mueller, Sabine, Mueller, Sabine, Fullerton, Heather J, Stratton, Kayla, Leisenring, Wendy, Weathers, Rita E, Stovall, Marilyn, Armstrong, Gregory T, Goldsby, Robert E, Packer, Roger J, Sklar, Charles A, Bowers, Daniel C, Robison, Leslie L, Krull, Kevin R, Mueller, Sabine, Mueller, Sabine, Fullerton, Heather J, Stratton, Kayla, Leisenring, Wendy, Weathers, Rita E, Stovall, Marilyn, Armstrong, Gregory T, Goldsby, Robert E, Packer, Roger J, Sklar, Charles A, Bowers, Daniel C, Robison, Leslie L, and Krull, Kevin R
- Abstract
PurposeTo test the hypotheses that (1) the increased risk of stroke conferred by childhood cranial radiation therapy (CRT) persists into adulthood; and (2) atherosclerotic risk factors further increase the stroke risk in cancer survivors.Methods and materialsThe Childhood Cancer Survivor Study is a multi-institutional retrospective cohort study of 14,358 5-year survivors of childhood cancer and 4023 randomly selected sibling controls with longitudinal follow-up. Age-adjusted incidence rates of self-reported late-occurring (≥5 years after diagnosis) first stroke were calculated. Multivariable Cox proportional hazards models were used to identify independent stroke predictors.ResultsDuring a mean follow-up of 23.3 years, 292 survivors reported a late-occurring stroke. The age-adjusted stroke rate per 100,000 person-years was 77 (95% confidence interval [CI] 62-96), compared with 9.3 (95% CI 4-23) for siblings. Treatment with CRT increased stroke risk in a dose-dependent manner: hazard ratio 5.9 (95% CI 3.5-9.9) for 30-49 Gy CRT and 11.0 (7.4-17.0) for 50+ Gy CRT. The cumulative stroke incidence in survivors treated with 50+ Gy CRT was 1.1% (95% CI 0.4-1.8%) at 10 years after diagnosis and 12% (95% CI 8.9-15.0%) at 30 years. Hypertension increased stroke hazard by 4-fold (95% CI 2.8-5.5) and in black survivors by 16-fold (95% CI 6.9-36.6).ConclusionYoung adult pediatric cancer survivors have an increased stroke risk that is associated with CRT in a dose-dependent manner. Atherosclerotic risk factors enhanced this risk and should be treated aggressively.
- Published
- 2013
20. Long-term follow-up of children treated for high-grade gliomas: Children's Oncology Group L991 final study report
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Sands, Stephen Alan, Zhou, Tianni, O'Neil, Sharon Helene, Patel, Sunita K., Allen, Jeffrey, Cullen, Patsy Mc Guire, Kaleita, Thomas A., Noll, Robert, Sklar, Charles, Finlay, Jonathan Lester, Sands, Stephen Alan, Zhou, Tianni, O'Neil, Sharon Helene, Patel, Sunita K., Allen, Jeffrey, Cullen, Patsy Mc Guire, Kaleita, Thomas A., Noll, Robert, Sklar, Charles, and Finlay, Jonathan Lester
21. Long-term follow-up of children treated for high-grade gliomas: Children's Oncology Group L991 final study report
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Sands, Stephen Alan, Zhou, Tianni, O'Neil, Sharon Helene, Patel, Sunita K., Allen, Jeffrey, Cullen, Patsy Mc Guire, Kaleita, Thomas A., Noll, Robert, Sklar, Charles, Finlay, Jonathan Lester, Sands, Stephen Alan, Zhou, Tianni, O'Neil, Sharon Helene, Patel, Sunita K., Allen, Jeffrey, Cullen, Patsy Mc Guire, Kaleita, Thomas A., Noll, Robert, Sklar, Charles, and Finlay, Jonathan Lester
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