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

• Authors: David J. Carpenter, Duke University; Yvonne M. Mowery, Duke University Health System; Gloria Broadwater, Duke University Health System; Anna Rodrigues, Duke University Health System; Amy J. Wisdom, Duke University; Jennifer A. Dorth, Case Western Reserve University; Pretesh Patel, Emory University; Cynthia K. Shortell, Duke University; Robert Clough, Duke University Health System; David M. Brizel, Duke University
• Journal Title: Oral Oncology
• Volume: Volume 80
• Publisher: Elsevier: 12 months | 2018-05-01, Pages 9-15
• Type of Work: Article | Post-print: After Peer Review
• Publisher DOI: http://doi.org/10.1016/j.oraloncology.2018.02.021
• Subjects: Health Sciences, Oncology; Health Sciences, Medicine and Surgery; Health Sciences, Epidemiology
• Keywords: Science & Technology; Life Sciences & Biomedicine; Oncology; Dentistry, Oral Surgery & Medicine; Carotid stenosis; Head and neck neoplasms; Radiotherapy; Radiation effects; Cerebrovascular disorders; NASOPHARYNGEAL CARCINOMA PATIENTS; CORONARY-ARTERY-DISEASE; PANORAMIC RADIOGRAPHY; ASYMPTOMATIC PATIENTS; SURGERY PATIENTS; ISCHEMIC-STROKE; RADIOTHERAPY; IRRADIATION; ATHEROSCLEROSIS; MALIGNANCIES

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.