Modifiable vascular risk factors are associated with progression of post-radiation carotid artery stenosis
Ya-wen Cheng, MD 1 , Chih-Hao Chen, PhD, MD 1 , Shin-Jeo Yeh, PhD, MD 1 , Li-Kai Tsai, PhD, MD 1 , Sung-Chun Tang, PhD, MD 1 , Jiann- Shing Jeng, PhD, MD 1 ,
1 Department of Neurology, National Taiwan University Hospita, Taipei, Taiwan
Sung-Chun Tang , PhD, MD
Department of Neurology, National Taiwan University Hospita, Taipei, Taiwan
Post-radiation carotid artery stenosis (CAS) is an uncommon complication in patients with head and neck cancers. This study aims to identify factors that are significantly associated with the progression of CAS in these patients.
MATERIAL and METHOD:
We retrospectively reviewed pWe retrospectively reviewed patients who had head and neck cancers and receivedunderwent radiotherapy for head and neck cancers from the department of oncology for carotid duplex examinations from October 2011/10/01 to May 2019/05/31 in National Taiwan University Hospital. Those who had received two consecutive carotid duplex examinations between an interval of 1 to 3 years were included.. To identify factors associated with the progression of carotid atherosclerosis, those who had only one carotid duplex examination, had two carotid duplex examinations but within a very short period (< one year) or long period (> three years) or had incomplete clinical data were excluded. The severity of CAS was evaluated by the modified plaque scoring system, and the progression of CAS was defined as the an increase of plaque score ≥33 or more in on either side of the carotid artery between two examinations.
During the study period, 736 patients (age 57.9±9.9 years; male, 75.1%; nasopharyngeal cancer, 73.2%) had received at least two examinations. The mean duration between the last radiation and first carotid duplex examination was 99.1±77.4 months. At baseline, higher severity of plaque scores was significantly associated with hypertension, smoking, drinking, coronary artery disease, previous stroke, conventional type of radiotherapy, and longer duration after the last radiotherapy. Of 736 patients, 119 (16.2%) had the progression of CAS. Patients with progression of CAS were more likely to have hypertension, diabetes mellitus, hypercholesterolemia, nasopharyngeal cancer in cancer types, and higher baseline plaque scores. Multivariable analysis shows that nasopharyngeal cancer (OR=2.45, 95% CI 1.41-4.27, p=0.001], baseline plaque score (OR=1.13, 95% CI 1.07-1.20, p <0.001], and hypercholesterolemia (OR=1.768, 95% CI 1.16-2.70, p=0.009] were independently associated with the progression of CAS.
Besides cancer type and baseline severity, our study suggested that modifiable vascular risk factors are crucially involved in the progression of post-radiation CAS in patients with head and neck cancers.