Radiation induced Arteriopathy and Stroke Risk in Children with Cancer treated with Cranial Radiation Therapy (RadArt) Study.

PI: Sabine Mueller

STATUS: Enrolling, Active
FUNDING: Lindsay and Deborah Laroche Research Fund

It is well documented that children who received cranial radiation therapy (CRT) for an underlying cancer diagnosis are at greater risk of developing radiation related morbidities such as endocrinopathies as well as neuro-cognitive sequelae. More recently, retrospective analyses have shown that these children also have a significant elevated stroke risk compared to the general population that continues to increase the further these children are out from therapy. Brain tumor patients are particularly vulnerable since these patients receive very high radiation dosages to the brain and the risk of stroke appears to correlate with increasing radiation dose. The underlying mechanism for the increased stroke risk is thought to be a radiation-induced vasculopathy, however we plan to further characterize this by including brain tumor patients who have not received radiation therapy. The rate and timing of the development of the radiation-induced vasculopathy is unknown since children are not routinely monitored with vascular imaging. Furthermore, among those with first stroke, rates and predictors of recurrent stroke have never been assessed.  Other pediatric stroke data have suggested that children with an underlying arteriopathy have an extraordinarily high risk of recurrent stroke:  66% at 5 years.  Children with radiation arteriopathy likely fall into this high-risk category, but these pediatric stroke studies lacked sufficient numbers to analyze this subgroup.

In this current study we aim to collect prospective clinical and imaging data to assess the incidence and timing of radiation induced vasculopathy (small and larger vessel) in children treated with radiation therapy to the brain and/or neck. For brain tumor patients who have not received radiation therapy we similarly plan to collect prospective clinical and imaging data to assess the incidence and timing of developing vasculopathy. We will further define the cumulative incidence of stroke and stroke recurrence in this population in children treated on current therapeutic protocols. Secondary aims will include the effect of stroke on QOL and neuro-cognition in these patients as well as the feasibility of collecting DNA and RNA.