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

Journal Article (Journal Article)

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.

Full Text

Duke Authors

Cited Authors

  • Carpenter, DJ; Mowery, YM; Broadwater, G; Rodrigues, A; Wisdom, AJ; Dorth, JA; Patel, PR; Shortell, CK; Clough, R; Brizel, DM

Published Date

  • May 2018

Published In

Volume / Issue

  • 80 /

Start / End Page

  • 9 - 15

PubMed ID

  • 29706194

Pubmed Central ID

  • PMC6827433

Electronic International Standard Serial Number (EISSN)

  • 1879-0593

Digital Object Identifier (DOI)

  • 10.1016/j.oraloncology.2018.02.021


  • eng

Conference Location

  • England