Meningioma and stroke among long-term childhood cancer survivors and recommendations for survivorship care

Long term adverse side events among childhood cancer survivors (CCS) can negatively impact quality of life. A concern are late effects among CCS treated with radiotherapy directed to the upper body (i.e. brain, neck, and thorax, including spinal radiotherapy and total body irradiation). Damage to these areas might induce cerebrovascular events or subsequent central nervous system (CNS) tumors, including meningiomas. To improve quality of late effects care for survivors, clinical research studying long term adverse events is crucial. Evidence-based guidelines and recommendations are warranted to permit deliberate choices in clinical decision-making. The objectives of this thesis are: a) to increase knowledge on risk factors and clinical characteristics of late effects in CCS after treatment with upper body radiotherapy; b) to provide guidance on surveillance of Childhood Adolescent Young Adult cancer survivors (CAYA cancer survivors) with respect to subsequent CNS tumors and concerning COVID-19.
In the first part of this thesis two retrospective clinical research studies are presented concerning cerebrovascular events (CVE) and meningioma as long-term adverse events after upper body radiotherapy. These studies are embedded within the Dutch Childhood Cancer Survivor Study (CCSS) LATER cohort. This cohort includes survivors who are diagnosed <age 18 years with childhood cancer in the period 1963-2002, and who survived ≥5 years after childhood cancer diagnosis. In the second part of this thesis guidance is provided for clinical practice. The development of recommendations for surveillance of subsequent CNS tumors among CAYA cancer survivors, and recommendations for CAYA cancer survivors with regard to COVID-19 are described.