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. 2018 May:80:9-15.
doi: 10.1016/j.oraloncology.2018.02.021. Epub 2018 Mar 14.

The risk of carotid stenosis in head and neck cancer patients after radiation therapy

David J Carpenter  1 , Yvonne M Mowery  2 , Gloria Broadwater  3 , Anna Rodrigues  2 , Amy J Wisdom  1 , Jennifer A Dorth  4 , Pretesh R Patel  5 , Cynthia K Shortell  6 , Robert Clough  2 , David M Brizel  7
Affiliations

The risk of carotid stenosis in head and neck cancer patients after radiation therapy

David J Carpenter et al. Oral Oncol. 2018 May.

Abstract

Objectives: Head and neck radiotherapy (RT) is a risk factor for cerebrovascular disease. We performed a retrospective cohort study to evaluate carotid artery stenosis (CAS) incidence in head and neck cancer (HNC) patients undergoing RT, characterizing associated risk factors.

Materials and methods: Records were retrospectively reviewed for HNC patients undergoing carotid ultrasound screening after definitive or adjuvant RT between January 2000 and May 2016. CAS was defined as ≥50% stenosis on imaging, stroke, or transient ischemic attack. Actuarial CAS rates were calculated by Kaplan-Meier method. Univariate and multivariate analyses predicted CAS risk based on carotid dosimetric and clinical parameters.

Results: 366 patients met inclusion criteria. Median time from RT completion to last follow-up was 4.1 yr. Actuarial risk for CAS was 29% (95% CI 22-36%) at 8 years. Univariate analysis showed that smoking (HR 1.7; 95% CI 1.1-2.7), hyperlipidemia (HR 1.6; 95% CI 1.03-2.6), diabetes (HR 2.8; 95% CI 1.6-4.8), coronary artery disease (HR 2.4; 95% CI 1.4-4.2), and peripheral artery disease (HR 3.6; 95% CI 1.1-11.6) were significantly associated with increased CAS. In multivariate analysis, diabetes was predictive of time to CAS (HR 1.9; 95% CI 1.1-3.4). Carotid dose parameters were not significantly associated with CAS.

Conclusions: CAS incidence is high after head and neck radiotherapy, gradually rising over time. No clear dose-response effect between carotid dose and CAS was identified for HNC patients. Carotid artery screening and preventative strategies should be employed in this high-risk patient population.

Keywords: Carotid stenosis; Cerebrovascular disorders; Head and neck neoplasms; Radiation effects; Radiotherapy.

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Conflict of interest statement

Conflict of interest

None declared.

Figures

Fig. 1.
Fig. 1.
Consort diagram demonstrating study inclusion criteria. Abbreviations: RT, radiation therapy; OSH, outside hospital; HNC, head and neck cancer; CVE, cerebrovascular event; US, ultrasound; ENT, otolaryngology; CAS, carotid artery stenosis.
Fig. 2.
Fig. 2.
(A) Cumulative incidence of composite carotid artery stenosis (asymptomatic CAS, stroke, or TIA) is shown with 95% CI provided for years post-RT completion with number at risk ≥20. (B) Cumulative incidence of asymptomatic carotid artery stenosis is shown with 95% CI provided for years post-RT completion with number at risk ≥20.
See this image and copyright information in PMC

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