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Review
. 2025 Oct;42(10):4768-4796.
doi: 10.1007/s12325-025-03314-4. Epub 2025 Aug 4.

Global Incidence and Mortality of Myocardial Infarction in Multi-Modality Head and Neck Cancer Treatment: A Systematic Review and Meta-analysis

Ameya A Asarkar  1 , Srivatsa Surya Vasudevan  2 , Veronica Fernandez-Alvarez  3 , Jan B Vermorken  4 , Fernando López Álvarez  5 , Karthik N Rao  6 , Nabil F Saba  7 , Remco de Bree  8 , Carlos Suárez  9 , Avraham Eisbruch  10 , Sandra Nuyts  11   12 , Carol Bradford  13 , Alfio Ferlito  14
Affiliations
Review

Global Incidence and Mortality of Myocardial Infarction in Multi-Modality Head and Neck Cancer Treatment: A Systematic Review and Meta-analysis

Ameya A Asarkar et al. Adv Ther. 2025 Oct.

Abstract

Introduction: Myocardial infarction (MI) incidence and mortality vary following multi-modality treatment for head and neck cancer (HNC). This systematic review and meta-analysis evaluate these rates.

Methods: We searched PubMed, Embase, ScienceDirect, and Web of Science (inception to March 2025) for studies reporting MI incidence or mortality after HNC treatment. A random-effects meta-analysis yielded pooled proportions. Subgroup analyses examined variations by treatment modality, time period (pre-/post-2010), and geography.

Results: Of 680 studies, 53 were included, encompassing 85,948 patients with HNC. The global pooled MI incidence was 1.7% (95% CI 1.2-2.3%), decreasing from 2.6% (pre-2010) to 1.5% (post-2010). Incidence was lowest with upfront surgery alone (1.2%) and higher with surgery plus adjuvant therapy (2.7%), primary chemoradiotherapy (CRT) (2.3%), radiotherapy (RT) alone (2.4%), or chemotherapy (CT) alone (2.1%). Global pooled MI mortality was 42.1% (95% CI 15.3-74.6%), declining from 49.8% (pre-2010) to 36.0% (post-2010). Male sex (p = 0.01) and longer follow-up in the RT group (p = 0.01) were associated with higher MI incidence via meta-regression; longer follow-up was also linked to higher mortality (p = 0.028).

Conclusion: This systematic review (PROSPERO: CRD420251040579) estimated the global MI incidence post-HNC treatment to be 1.7%, with the lowest after surgery alone and no significant geographic variation. MI mortality is high (42.1%) but has decreased over time. These findings demonstrate significant cardiovascular burden associated with HNC treatment, particularly non-surgical modalities, highlighting the need for targeted cardiovascular surveillance strategies.

Keywords: Combined modality therapy; Head and neck cancer; Incidence; Mortality; Myocardial infarction; Myocardial infarction incidence.

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Conflict of interest statement

Declarations. Conflict of Interest: Alfio Ferlito is a board member of Advances in Therapy. Alfio Ferlito was not involved in the selection of peer reviewers for the manuscript nor any of the subsequent editorial decisions. Ameya A. Asarkar; Srivatsa Surya Vasudevan; Veronica Fernandez Alvarez; Jan B. Vermorken; Fernando López Álvarez; Karthik N Rao; Nabil F. Saba; Remco de Bree; Carlos Suárez; Avraham Eisbruch; Sandra Nuyts and Carol Bradford declare no conflicts of interest. Ethical Approval: This article is based on previously conducted studies and does not contain any new studies with human participants or animals performed by any of the authors.

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