Kouli, O. O., McLoone, P. , Morrison, D., Zaorsky, N. G. and Chalmers, A. J. (2023) Risk of stroke-specific mortality after radiotherapy in patients with primary brain tumours. Clinical and Translational Radiation Oncology, 42, 100658. (doi: 10.1016/j.ctro.2023.100658) (PMID:37502698) (PMCID:PMC10368762)
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Abstract
Introduction: Stroke is an established complication in cancer patients, amongst whom brain tumour patients have the highest risk of fatal stroke. Radiotherapy is an important treatment for brain tumours and is associated with increased risk of cerebrovascular disease. However, the impact of brain irradiation on stroke-related deaths in brain tumour patients is unknown, and the timing of any effect uncertain. This study investigates the relationship between radiotherapy and stroke-specific mortality (SSM) in patients with primary brain tumours. Methods: Patients of any age diagnosed with histologically confirmed primary brain tumours between 1992 and 2015 were abstracted from the Surveillance, Epidemiology, and End Results (SEER) database. Primary outcome was impact of radiotherapy on 5-year SSM. Cumulative SSM rates under competing risk assumptions were estimated and stratified by intervention type. Time-dependent hazard ratios were estimated to identify when the radiotherapy impact was greatest. Results: 85,284 patients with primary brain tumour diagnoses were analysed. Overall, the 5-year cumulative SSM rate was low (0.6%) with the highest rate (0.76%) in patients receiving no treatment, in whom it mainly occurred <1 month after diagnosis. SSM rates were lower in patients treated with radiotherapy alone (0.27%) or radiotherapy plus surgery (0.24%); stroke-related deaths also occurred later in these groups. While these patterns were observed in both glioblastoma and non-glioblastoma patients, stroke deaths tended to occur later in non-glioblastoma patients receiving radiotherapy. Relative to the ‘no treatment’ group, the highest risk of stroke mortality in radiotherapy treated patients occurred 3.5-4 years after diagnosis. Conclusion: The risk of SSM is low in patients with primary brain tumours and is not increased by radiotherapy. Two different patterns were observed: acute stroke mortality in patients receiving no treatment, and delayed stroke mortality in patients receiving radiotherapy (+/- surgery) with the latter peaking 3.5-4 years after diagnosis.
| Item Type: | Articles |
|---|---|
| Status: | Published |
| Refereed: | Yes |
| Glasgow Author(s) Enlighten ID: | McLoone, Mr Philip and Chalmers, Professor Anthony and Kouli, Dr Omar and Morrison, Dr David |
| Authors: | Kouli, O. O., McLoone, P., Morrison, D., Zaorsky, N. G., and Chalmers, A. J. |
| College/School: | College of Medical Veterinary and Life Sciences > School of Cancer Sciences College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Public Health College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing |
| Journal Name: | Clinical and Translational Radiation Oncology |
| Publisher: | Elsevier |
| ISSN: | 2405-6308 |
| ISSN (Online): | 2405-6308 |
| Published Online: | 06 July 2023 |
| Copyright Holders: | Copyright © 2023 The Authors |
| First Published: | First published in Clinical and Translational Radiation Oncology 42: 100658 |
| Publisher Policy: | Reproduced under a Creative Commons License |
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