Affiliation:
1. Department of Radiation Oncology Duke Cancer Institute Durham North Carolina USA
2. Department of Biostatistics & Bioinformatics Duke University Medical Center Durham North Carolina USA
3. Duke Cancer Institute Biostatistics Duke University Medical Center Durham North Carolina USA
4. Department of Head and Neck Surgery and Communication Sciences Duke University Medical Center Durham North Carolina USA
5. Department of Radiation Oncology Dana‐Farber/Brigham and Women's Cancer Center Harvard Medical School Boston Massachusetts USA
6. Department of Radiation Oncology Case Western Reserve University Cleveland Ohio USA
7. Department of Radiation Oncology Winship Cancer Institute of Emory University Atlanta Georgia USA
8. Department of Surgery Duke University Medical Center Durham North Carolina USA
Abstract
AbstractBackgroundRecipients of radiation therapy (RT) for head and neck cancer (HNC) are at significantly increased risk for carotid artery stenosis (CAS) and cerebrovascular disease (CVD). We sought to determine (1) cumulative incidences of CAS and CVD among HNC survivors after RT and (2) whether CAS is associated with a RT dose response effect.MethodsThis single‐institution retrospective cohort study examined patients with nonmetastatic HNC who completed (chemo)RT from January 2000 through October 2020 and subsequently received carotid imaging surveillance ≤2 years following RT completion and, in the absence of CAS, every 3 years thereafter. Exclusion criteria included history of known CAS/CVD. Asymptomatic CAS was defined as ≥50% reduction of luminal diameter, symptomatic CAS as stroke or transient ischemic attack, and composite CAS as asymptomatic or symptomatic CAS.ResultsOf 628 patients undergoing curative intent RT for HNC, median follow‐up was 4.8 years (interquartile range, 2.6–8.3), with 97 patients followed ≥10 years. Median age was 61 years and 69% of patients received concurrent chemotherapy and 28% were treated postoperatively. Actuarial 10‐year incidences of asymptomatic, symptomatic, and composite CAS were 29.6% (95% CI, 23.9–35.5), 10.1% (95% CI, 7.0–13.9), and 27.2% (95% CI, 22.5–32.1), respectively. Multivariable Cox models significant association between asymptomatic CAS and absolute carotid artery volume receiving ≥10 Gy (per mL: hazard ratio, 1.09; 95% CI, 1.02–1.16).ConclusionsHNC survivors are at high risk for post‐RT CAS. A dose response effect was observed for asymptomatic CAS at doses as low as 10 Gy.Plain Language Summary
Recipients of radiation therapy for head and neck cancer are at significantly increased risk for carotid artery stenosis and cerebrovascular disease. However, carotid artery screening is not routinely performed among head and neck survivors following radiation therapy.
In this single‐institution retrospective cohort study, patients with head and neck cancer were initially screened for carotid artery stenosis ≤2 years following radiation therapy completion, then every 3 years thereafter.
The 10‐year actuarial incidence of carotid artery stenosis was >25% and stroke/transient ischemic attack >10%. Multivariable analysis demonstrated significant associations between asymptomatic carotid artery stenosis and artery volumes receiving ≥10 Gy.