Interrogating the impact of cardiovascular risk factors on outcomes for patients with brain tumours
Dr P Brennan, Prof A Chalmers, Mr Michael Poon, Dr P Hall
About the Project
Central nervous system (CNS) tumours, both malignant and non-malignant, are associated with significant morbidity and mortality. Outcomes for patients have improved little in the last 20 years, principally because of a failure to identify new, effective therapies. Yet not all patients complete the regimens of existing therapies for which they are eligible. This reduces the effectiveness and potential survival benefit. We investigate non-tumour clinical features that affect patient survival and therapy efficacy.
Patients with a brain tumour diagnosis have a markedly increased risk of cardiovascular events, particularly in the first 12 months after diagnosis. Although higher mortality rates from stroke have been reported for all cancer patients compared with the general population, brain tumour patients have over 7-fold higher risk of fatal stroke. Tumour size is associated with increased risk, whilst surgery, chemotherapy and radiotherapy are associated with reduced risk (Brennan and Poon). In a study of the SEER database by the Chalmers group (manuscript in preparation), absolute rates of death from stroke were lower in patients treated with radiotherapy alone (0.27%) or radiotherapy plus surgery (0.24%) compared with patients who did not receive radiotherapy or surgery (0.76%); stroke related deaths also occurred later in patients who received radiotherapy, a trend that was accentuated in non-glioblastoma patients. Relative to the ‘no treatment’ group, the highest risk of stroke mortality in radiotherapy treated patients was observed 3.5-4 years after diagnosis.
It remains unknown which other tumour and treatment factors are associated with cerebrovascular events in patients with brain tumours. Nothing is reported about the non-fatal events which cause morbidity and impact on treatment. It’s also unknown whether or how pre-existing risk factors for CVD, or drug history, impact on these risks. This information is crucial if we are to establish what intervention is likely to be effective at reducing risk in this population.
A better understanding of tumour- and treatment-related factors associated with cerebrovascular events and morbidity should provide important insights for identification of high-risk groups, improved medical management, and prevention. This information will also inform understanding of putative mechanisms of increased cardiovascular risk, and cerebrovascular, risk.
Application procedure
Up to 4 studentships are available to start in September 2023 for outstanding applicants with a stipend of £21,000 p/a. These 4 STUDENTSHIPS are funded by the CRUK Scotland Centre, a joint initiative between Edinburgh and Glasgow. Successful students for Edinburgh lead projects will be registered for their degree in Edinburgh and will undertake their project in Edinburgh.
Candidates should hold at least an upper second-class degree in a relevant subject and comply with University of Edinburgh English language requirements.
For further information on how to apply, please visit: https://www.ed.ac.uk/cancer-centre/graduate-research-and-training/cancer-research-uk-phd-programme