BACKGROUND: Cervical radiation for head and neck cancer has been associated with an increased incidence of carotid arterial stenosis. Modern radiation therapy delivers higher doses with increasing long-term survival. Accordingly, the prevalence of radiation-associated carotid stenosis may be higher than previously reported. Phase I of this prospective study was to establish the prevalence of carotid artery stenosis after high-dose cervical radiation. METHODS: From a prospectively maintained database, we identified patients who had received cervical high-dose radiotherapy (minimum 5,500 cGy). All patients were screened with bilateral carotid arterial duplex ultrasonography. We defined disease as "normal or mild" if the carotid stenosis was <50%, and "significant" if >50%. The relationship between standard demographic risk factors and screening outcomes was then analyzed. RESULTS: Screening was performed in 40 patients (mean age 68.2 years, range 26 to 87). Patients received a mean cumulative radiation dose of 6,420 cGy (range 5,500 to 7,680), with a mean duration of 10.2 years since their last radiation treatment. Sixteen patients (40%) had significant carotid artery stenosis. Patients with and without significant stenosis were comparable in terms of age, radiation dose, tobacco use, comorbidities, and postradiation interval (P = not significant). Six patients (15%) had unilateral complete carotid occlusion and 6 patients (15%) had significant bilateral carotid stenosis. Three patients (7.5%) had sustained a previous stroke after radiation therapy. CONCLUSIONS: The prevalence of carotid arterial disease in patients with prior cervical radiation therapy is clinically significant and warrants aggressive screening as part of routine preradiation and postradiation care. Focused screening of this high-risk population may be cost effective and medically beneficial in terms of risk factor modification and stroke prevention, and will be examined in phase II of this study.
BACKGROUND: Cervical radiation for head and neck cancer has been associated with an increased incidence of carotid arterial stenosis. Modern radiation therapy delivers higher doses with increasing long-term survival. Accordingly, the prevalence of radiation-associated carotid stenosis may be higher than previously reported. Phase I of this prospective study was to establish the prevalence of carotid artery stenosis after high-dose cervical radiation. METHODS: From a prospectively maintained database, we identified patients who had received cervical high-dose radiotherapy (minimum 5,500 cGy). All patients were screened with bilateral carotid arterial duplex ultrasonography. We defined disease as "normal or mild" if the carotid stenosis was <50%, and "significant" if >50%. The relationship between standard demographic risk factors and screening outcomes was then analyzed. RESULTS: Screening was performed in 40 patients (mean age 68.2 years, range 26 to 87). Patients received a mean cumulative radiation dose of 6,420 cGy (range 5,500 to 7,680), with a mean duration of 10.2 years since their last radiation treatment. Sixteen patients (40%) had significant carotid artery stenosis. Patients with and without significant stenosis were comparable in terms of age, radiation dose, tobacco use, comorbidities, and postradiation interval (P = not significant). Six patients (15%) had unilateral complete carotid occlusion and 6 patients (15%) had significant bilateral carotid stenosis. Three patients (7.5%) had sustained a previous stroke after radiation therapy. CONCLUSIONS: The prevalence of carotid arterial disease in patients with prior cervical radiation therapy is clinically significant and warrants aggressive screening as part of routine preradiation and postradiation care. Focused screening of this high-risk population may be cost effective and medically beneficial in terms of risk factor modification and stroke prevention, and will be examined in phase II of this study.
Authors: David J Carpenter; Yvonne M Mowery; Gloria Broadwater; Anna Rodrigues; Amy J Wisdom; Jennifer A Dorth; Pretesh R Patel; Cynthia K Shortell; Robert Clough; David M Brizel Journal: Oral Oncol Date: 2018-03-14 Impact factor: 5.337
Authors: Verónica Fernández-Alvarez; Fernando López; Carlos Suárez; Primoz Strojan; Avraham Eisbruch; Carl E Silver; William M Mendenhall; Johannes A Langendijk; Alessandra Rinaldo; Anne W M Lee; Jonathan J Beitler; Robert Smee; Javier Alvarez; Alfio Ferlito Journal: Strahlenther Onkol Date: 2018-04-20 Impact factor: 3.621
Authors: Paul Harrod-Kim; Yasha Kadkhodayan; Colin P Derdeyn; DeWitte T Cross; Christopher J Moran Journal: AJNR Am J Neuroradiol Date: 2005-08 Impact factor: 3.825
Authors: Samuel Swisher-McClure; Nandita Mitra; Alexander Lin; Peter Ahn; Fei Wan; Bert O'Malley; Gregory S Weinstein; Justin E Bekelman Journal: Head Neck Date: 2013-07-02 Impact factor: 3.147
Authors: Kathleen A Meeske; Stuart E Siegel; Vicente Gilsanz; Leslie Bernstein; Mary B Nelson; Richard Sposto; Fred A Weaver; Robert S Lavey; M P H Wendy J Mack; Marvin D Nelson Journal: Pediatr Blood Cancer Date: 2009-10 Impact factor: 3.167