ESPE Abstracts

Objective: Childhood brain tumor survivors have an increased risk for developing cardiovascular disease, as a consequence of the primary disease itself and/or its treatment. Early detection of children at risk is important to take preventive measures. Carotid intima-media thickness (cIMT), determined with ultrasound, is a non-invasive biomarker of atherosclerosis in its subclinical stage. The study aimed to evaluate metabolic complications and determine cardiovascular risk with cIMT measurement in childhood brain tumor survivors

Methods: Childhood brain tumor survivors diagnosed at University Children’s Hospital, University Medical Center Ljubljana between 2008 and 2018, at least 5 years after completion of the oncologic treatment, were included in the study. Demographic data, tumor location, pathology, treatment modalities (surgery, radiation, chemotherapy), and medication use were collected from medical documentation. Participants were invited to an outpatient clinic for a detailed metabolic evaluation. Anthropometric and blood pressure measurements were performed. Blood was withdrawn between 8-9 am after fasting to determine glucose and insulin levels, evaluation of lipid profile, and endocrine axes. Body composition was determined by dual-energy X-ray absorptiometry. CIMT of the right common carotid artery was measured with a radiofrequency-based ultrasound system (RF-quality intima-media thickness, Esaote). Standard deviation scores of specific variables were calculated for comparison of the studied variables.

Results: From 98 brain tumor survivors, 84 were included in the study (mean age 15.5 +/- 5.7 yrs, mean follow-up time 8.1 +/- 3.1 yrs, 43 male). Most survivors had the primary tumor in the posterior fossa (41), followed by supratentorial (32) and suprasellar region (11). Based on combined BMI and body composition data (fat % SDS), 39/84 (46%) were classified as obese. Dyslipidemia (low HDL and/or elevated triglycerides) was present in 38/84 (45%) patients. Hypertension was not detected. Diabetes type 2 was diagnosed in 2 patients. CIMT above the 90^th percentile for age and sex was measured in 21/81 (26%) of patients. The finding was more common among survivors with dyslipidemia, higher BMI SDS values, and in those who received radiotherapy (P = 0.003, P = 0.001, P = 0.007). It was most frequent in those with tumors in the suprasellar region in comparison to the other locations (P = 0.021).

Conclusion: An increased cardiovascular risk determined by cIMT measurement was detected in more than a quarter of childhood brain tumor survivors early after oncologic treatment completion.