University of Oulu

Tiina Maria Remes, Maria Helena Suo-Palosaari, Päivi K T Koskenkorva, Anna K Sutela, Sanna-Maria Toiviainen-Salo, Pekka M Arikoski, Mikko O Arola, Vesa-Pekka Heikkilä, Mika Kapanen, Päivi Maria Lähteenmäki, Tuula R I Lönnqvist, Hannele Niiniviita, Tytti M-L Pokka, Liisa Porra, V Pekka Riikonen, Jan Seppälä, Kirsti H Sirkiä, Antti Vanhanen, Heikki M J Rantala, Arja H Harila-Saari, Marja K Ojaniemi, Radiation-induced accelerated aging of the brain vasculature in young adult survivors of childhood brain tumors, Neuro-Oncology Practice, Volume 7, Issue 4, August 2020, Pages 415–427,

Radiation-induced accelerated aging of the brain vasculature in young adult survivors of childhood brain tumors

Saved in:
Author: Remes, Tiina Maria1; Suo-Palosaari, Maria Helena2; Koskenkorva, Päivi K. T.3;
Organizations: 1Department of Pediatrics and Adolescence, PEDEGO Research Unit and Medical Research Center, Oulu University Hospital, and University of Oulu, Oulu, Finland
2Department of Diagnostic Radiology, Oulu University Hospital, and University of Oulu, Research Unit of Medical Imaging, Physics, and Technology, Faculty of Medicine, University of Oulu, and Medical Research Center Oulu, University of Oulu, Oulu, Finland
3Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland
4Department of Pediatric Radiology, HUS Medical Imaging Center, Radiology, University of Helsinki, and Helsinki University Hospital, Helsinki, Finland
5Department of Pediatrics and Adolescence, Kuopio University Hospital, University of Eastern Finland, Kuopio, Finland
6Department of Pediatrics, Tampere University Hospital, and University of Tampere, Tampere, Finland
7Department of Oncology and Radiotherapy, Oulu University Hospital, Oulu, Finland
8Department of Oncology and Department of Medical Physics, Tampere University Hospital, Tampere, Finland
9Department of Pediatrics and Adolescent Medicine, Turku University Hospital, and Turku University, Turku, Finland
10Department of Child Neurology, Children’s Hospital, University of Helsinki, and Helsinki University Hospital, Helsinki, Finland
11Department of Medical Physics, Division of Medical Imaging, Turku University Hospital, Turku, Finland
12Department of Oncology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
13Center of Oncology, Kuopio University Hospital, Kuopio, Finland
14Department of Pediatrics and Adolescence, Helsinki University, and Helsinki University Hospital, Helsinki, Finland
15Uppsala University, Department of Women’s and Children’s Health, Akademiska sjukhuset, Uppsala, Sweden
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 2.3 MB)
Persistent link:
Language: English
Published: Oxford University Press, 2020
Publish Date: 2020-09-01


Background: Cranial radiotherapy may damage the cerebral vasculature. The aim of this study was to understand the prevalence and risk factors of cerebrovascular disease (CVD) and white matter hyperintensities (WMHs) in childhood brain tumors (CBT) survivors treated with radiotherapy.

Methods: Seventy CBT survivors who received radiotherapy were enrolled in a cross-sectional study at a median 20 years after radiotherapy cessation. The prevalence of and risk factors for CVD were investigated using MRI, MRA, and laboratory testing. Tumors, their treatment, and stroke-related data were retrieved from patients’ files.

Results: Forty-four individuals (63%) had CVD at a median age of 27 years (range, 16–43 years). The prevalence rates at 20 years for CVD, small-vessel disease, and large-vessel disease were 52%, 38%, and 16%, respectively. Ischemic infarcts were diagnosed in 6 survivors, and cerebral hemorrhage in 2. Lacunar infarcts were present in 7, periventricular or deep WMHs in 34 (49%), and mineralizing microangiopathy in 21 (30%) survivors. Multiple pathologies were detected in 44% of the participants, and most lesions were located in a high-dose radiation area. Higher blood pressure was associated with CVD and a presence of WMHs. Higher cholesterol levels increased the risk of ischemic infarcts and WMHs, and lower levels of high-density lipoprotein and higher waist circumference increased the risk of lacunar infarcts.

Conclusions: Treating CBTs with radiotherapy increases the risk of early CVD and WMHs in young adult survivors. These results suggest an urgent need for investigating CVD prevention in CBT patients.

see all

Series: Neuro-oncology practice
ISSN: 2054-2577
ISSN-E: 2054-2585
ISSN-L: 2054-2577
Volume: 7
Issue: 4
Pages: 415 - 427
DOI: 10.1093/nop/npaa002
Type of Publication: A1 Journal article – refereed
Field of Science: 3122 Cancers
3123 Gynaecology and paediatrics
Funding: This work was supported by Special State Grants for Health Research in the Department of Pediatrics and Adolescence, Oulu University Hospital, Finland, the Väre Foundation for Pediatric Cancer Research, Finland, the Foundation of Päivikki and Sakari Sohlberg, Finland, the Foundation of Arvo and Lea Ylppö, Finland, the Foundation for Pediatric Research, Finland, the Foundation of Emil Aaltonen, Finland, the Foundation of Thelma Mäkikyrö, Finland, the Cancer Foundation of Northern Finland, the Foundation of Alma and K. A. Snellman, Finland, and the Foundation of Märta Donner, Finland (to T.R.), and the Cancer Society of Finland (to H.R., A.H.-S., and M.O.).
Copyright information: © The Author(s) 2020. Published by Oxford University Press on behalf of the Society for Neuro-Oncology and the European Association of Neuro-Oncology. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.