David J Carpenter1, Yvonne M Mowery2, Gloria Broadwater3, Anna Rodrigues2, Amy J Wisdom1, Jennifer A Dorth4, Pretesh R Patel5, Cynthia K Shortell6, Robert Clough2, David M Brizel7. 1. Duke University School of Medicine, Durham, NC, USA. 2. Department of Radiation Oncology, Duke Cancer Institute, USA. 3. Department of Biostatistics, Duke Cancer Institute, USA. 4. Department of Radiation Oncology, Case Western Reserve University, Cleveland, OH, USA. 5. Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, GA, USA. 6. Department of Surgery, Duke University Medical Center, USA. 7. Department of Radiation Oncology, Duke Cancer Institute, USA; Department of Surgery, Duke University Medical Center, USA. Electronic address: david.brizel@duke.edu.
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.
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 HNCpatients 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 HNCpatients. Carotid artery screening and preventative strategies should be employed in this high-risk patient population.
Authors: Joseph D Martin; Anne R Buckley; Doug Graeb; Brenda Walman; Anthony Salvian; John H Hay Journal: Int J Radiat Oncol Biol Phys Date: 2005-06-22 Impact factor: 7.038
Authors: John J Ricotta; Ali Aburahma; Enrico Ascher; Mark Eskandari; Peter Faries; Brajesh K Lal Journal: J Vasc Surg Date: 2011-09 Impact factor: 4.268
Authors: Paul D Brown; Robert L Foote; Mark P McLaughlin; Michele Y Halyard; Karla V Ballman; A Craig Collie; Robert C Miller; Kelly D Flemming; John W Hallett Journal: Int J Radiat Oncol Biol Phys Date: 2005-09-19 Impact factor: 7.038
Authors: Adnan I Qureshi; Andrei V Alexandrov; Charles H Tegeler; Robert W Hobson; J Dennis Baker; L Nelson Hopkins Journal: J Neuroimaging Date: 2007-01 Impact factor: 2.486
Authors: R S D'Agostino; L G Svensson; D J Neumann; H H Balkhy; W A Williamson; D M Shahian Journal: Ann Thorac Surg Date: 1996-12 Impact factor: 4.330
Authors: Carrie M Carr; John C Benson; David R DeLone; Felix E Diehn; Dong K Kim; Daniel Ma; Alex A Nagelschneider; Ajay A Madhavan; Derek R Johnson Journal: Neuroradiol J Date: 2022-05-01
Authors: D Strüder; S Hellwig; H Rennau; S van Bonn; S P Schraven; R Mlynski; G Hildebrandt; T Schuldt Journal: Eur Arch Otorhinolaryngol Date: 2020-09-01 Impact factor: 2.503