(CSEMP025) STROKE RISK IN CHILDHOOD, ADOLESCENT, AND YOUNG ADULT CANCER SURVIVORS WHO RECEIVED CRANIAL RADIOTHERAPY

Abstract: Background. Childhood, adolescent, and young adult (CAYA) cancer survivors who received cranial radiotherapy have an increased risk of stroke. Traditional cardiovascular disease (CVD) risk factors likely contribute, but there are no guidelines for the management of stroke risk in this population. It is unclear how general CVD risk calculators (Framingham Risk Score, QRISK3) compare to specific cancer survivors scores such as the Childhood Cancer Survivors Study Stroke Risk Calculator (CCSS).
Objective. Our aim is to describe traditional CVD risk factors in an UK CAYA survivor population and to compare the outcomes of 3 risk calculator models (FRS, QRISK3 and CCSS).
Results. 99 CAYA patients identified from consecutive late effects clinics at a tertiary oncology center from March-May 2021 were included. The mean age was 35.4 (SD 10.5) years old, with a mean age at the time of cancer diagnosis of 11.8 (SD 5.6) years old. Among the participants, 46% were female and 86% were of Caucasian ethnicity. Risk factor data were available for 89.9% of the cohort and demonstrate that 7% were active smokers, 12% were diabetic, mean HbA1c was 39.3 (SD 19.8) mmol/mol, mean Chol:HDL was 3.9 (SD 1.1) and mean SBP was 127 (SD 16) mmHg. 90% received cranial radiotherapy with a mean dose of 47.5 (SD 8.9) Gy. The most frequently seen neoplasms included astrocytoma (23.2%), medulloblastoma (22.2%) and germinoma (13.1%).
For patients with calculable FRS, QRISK3 and CCSS scores, 94.4% (n=17) and 100% (n=38) who had a CCSS 10-year stroke risk of 5-20% had a lower predicted risk of CVD using FRS and QRISK3, respectively. Patients who had cranial radiotherapy were more likely to have an underestimated common CVD calculator score. Neither FRS nor QRISK3 overestimated the risk calculated by CCSS. 6 patients in our cohort had a stroke, but their CCSS score could not be calculated as their age were > 40 years old.
Conclusion. Common CVD risk prediction tools underestimate the risk of stroke compared to the CCSS calculator.