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Abstract：
Radiotherapy (RT) is a recognized risk factor for cerebrovascular (CV) disease in children and in adults with head and neck cancer. We aimed to investigate whether cerebral RT increases the risk of CV disease in adults with primary brain tumors (PBT).
We retrospectively identified adults with a supratentorial PBT diagnosed between 1975 and 2006 and with at least 10 years follow-up after treatment. We analyzed demographic, clinical, and radiological features with special attention to CV events. We also described CV events, vascular risk factors, and intracranial artery modifications in a cross-sectional study of irradiated patients alive at the time of the study.
A total of 116 patients, treated with RT (exposed group), and 85 non-irradiated patients (unexposed group) were enrolled. Stroke was more frequent in irradiated PBT patients than in the unexposed group (42/116 (36%) vs 7/85 (8%); p < 0.001), with higher prevalence of both ischemic (27/116 (23%) vs 6/85 (7%); p = 0.004) and hemorrhagic (12/116 (10%) vs 1/85 (1%); p = 0.02) stroke. In the irradiated group, patients with tumors near the Willis Polygon were more likely to experience stroke (p < 0.016). Fourty-four alive irradiated patients were included in the cross-sectional study. In this subgroup, intracranial arterial stenosis was more prevalent (11/45, 24%) compared to general population (9%).
Stroke prevalence is increased in long-surviving PBT patients treated with cranial RT.
CV events are frequent in long survivors of PBT treated with cerebral RT. We propose a check list to guide management of late CV complications in adults treated with RT for PBT.
We retrospectively identified adults with a supratentorial PBT diagnosed between 1975 and 2006 and with at least 10 years follow-up after treatment. We analyzed demographic, clinical, and radiological features with special attention to CV events. We also described CV events, vascular risk factors, and intracranial artery modifications in a cross-sectional study of irradiated patients alive at the time of the study.
A total of 116 patients, treated with RT (exposed group), and 85 non-irradiated patients (unexposed group) were enrolled. Stroke was more frequent in irradiated PBT patients than in the unexposed group (42/116 (36%) vs 7/85 (8%); p < 0.001), with higher prevalence of both ischemic (27/116 (23%) vs 6/85 (7%); p = 0.004) and hemorrhagic (12/116 (10%) vs 1/85 (1%); p = 0.02) stroke. In the irradiated group, patients with tumors near the Willis Polygon were more likely to experience stroke (p < 0.016). Fourty-four alive irradiated patients were included in the cross-sectional study. In this subgroup, intracranial arterial stenosis was more prevalent (11/45, 24%) compared to general population (9%).
Stroke prevalence is increased in long-surviving PBT patients treated with cranial RT.
CV events are frequent in long survivors of PBT treated with cerebral RT. We propose a check list to guide management of late CV complications in adults treated with RT for PBT.
摘要：
目的：放射治疗（RT）是儿童和成人头颈癌脑血管（CV）疾病的公认危险因素。我们的目的是研究脑RT是否会增加成人原发性脑肿瘤（PBT）的CV疾病风险。
方法：我们回顾性地确定了1975年至2006年间诊断为幕上PBT的成年人，并在治疗后至少随访10年。我们分析了人口统计，临床,和放射学特征，特别注意CV事件。我们还描述了CV事件，血管危险因素，在一项横断面研究中，对研究时存活的受照射患者进行了颅内动脉修饰。
结果：共有116名患者，接受RT（暴露组）治疗，纳入85例未经照射的患者（未照射组）。受照射的PBT患者的卒中发生率高于未暴露组（42/116（36％）vs7/85（8％）；p<0.001），缺血性卒中(27/116(23%)vs6/85(7%);p=0.004)和出血性卒中(12/116(10%)vs1/85(1%);p=0.02)的患病率较高。在受照射的组中，肿瘤靠近WillisPolygon的患者更有可能发生卒中(p<0.016).横断面研究中包括了44名活着的接受过照射的患者。在这个子群中,与普通人群(9%)相比,颅内动脉狭窄更为普遍(11/45,24%).
结论：在接受头颅RT治疗的长期存活的PBT患者中，卒中患病率增加。
结论：CV事件在接受脑RT治疗的PBT长期存活者中常见。我们提出了一份清单，以指导接受RT治疗的成人PBT的晚期CV并发症的管理。
方法：我们回顾性地确定了1975年至2006年间诊断为幕上PBT的成年人，并在治疗后至少随访10年。我们分析了人口统计，临床,和放射学特征，特别注意CV事件。我们还描述了CV事件，血管危险因素，在一项横断面研究中，对研究时存活的受照射患者进行了颅内动脉修饰。
结果：共有116名患者，接受RT（暴露组）治疗，纳入85例未经照射的患者（未照射组）。受照射的PBT患者的卒中发生率高于未暴露组（42/116（36％）vs7/85（8％）；p<0.001），缺血性卒中(27/116(23%)vs6/85(7%);p=0.004)和出血性卒中(12/116(10%)vs1/85(1%);p=0.02)的患病率较高。在受照射的组中，肿瘤靠近WillisPolygon的患者更有可能发生卒中(p<0.016).横断面研究中包括了44名活着的接受过照射的患者。在这个子群中,与普通人群(9%)相比,颅内动脉狭窄更为普遍(11/45,24%).
结论：在接受头颅RT治疗的长期存活的PBT患者中，卒中患病率增加。
结论：CV事件在接受脑RT治疗的PBT长期存活者中常见。我们提出了一份清单，以指导接受RT治疗的成人PBT的晚期CV并发症的管理。
