Prevalence of carotid stenosis following radiotherapy for head and neck cancer: A systematic review and meta‐analysis

Texakalidis, Pavlos; Giannopoulos, Stefanos; Tsouknidas, Ioannis; Song, Shiyu; Rivet, Dennis J.; Reiter, Evan R.; Reavey‐Cantwell, John

doi:10.1002/hed.26102

Cited by 27 publications

(30 citation statements)

References 42 publications

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“…Radiation to the neck has been linked to CA stenosis, and rarely to CA rupture, representing a significant risk for head and neck cancer patients, including laryngectomees [ 12 ]. Screening ultrasound within the first year since completion of radiotherapy, followed by repeat ultrasounds every 2–3 years and whenever CA stenosis is suspected can lead to early diagnosis.…”

Section: Discussionmentioning

confidence: 99%

Correction of carotid artery stenosis by stent placement ameliorated paroxysmal hypertension after radiation treatment of hypopharyngeal carcinoma: a case report

Brook

Cohen²,

Stemer

2022

J Med Case Reports

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Background Paroxysmal hypertension can be associated with failure of the carotid artery baroreceptors due to past exposure to radiation treatment. This report describes a patient whose repeated paroxysmal hypertensive episodes were ameliorated following placement of a carotid artery stent for the treatment of carotid artery stenosis. Case report A 79-year-old caucasian male was diagnosed with hypopharyngeal squamous cell carcinoma (T1, L0, M0) in 2006, and received 70 Gy intensity-modulated radiotherapy in 2006 and underwent a total laryngectomy in 2008. He experienced paroxysmal hypertensive episodes since 2010 that exacerbated in frequency in 2019. Eighty percent left internal carotid artery stenosis was demonstrated by ultrasound and arteriography. Angioplasty and stenting of the left carotid artery was performed. A Doppler ultrasound study performed 5 months after the stent placement did not reveal any hemodynamic stenosis in the left carotid artery. The patient experienced postprandial hypotension and had experienced only three episodes of paroxysmal hypertension in the following 24 months. He was able to abort paroxysmal hypertensive episodes by eating warm food. Discussion This is the first report of a patient whose paroxysmal hypertensive episodes that occurred following radiation of the neck subsided after placement of a stent in a stenotic carotid artery. The exact mechanism leading to this phenomena is unknown but may be due to several factors. The reversal of the carotid artery stent and improvement in blood flow to the carotid artery baroceptors may play a role in this phenomenon. Conclusion The ability to ameliorate paroxysmal hypertensive episodes in a patient with carotid artery stenosis by stent placement may be a promising therapeutic intervention for paroxysmal hypertension.

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Section: Discussionmentioning

confidence: 99%

Correction of carotid artery stenosis by stent placement ameliorated paroxysmal hypertension after radiation treatment of hypopharyngeal carcinoma: a case report

Brook

Cohen²,

Stemer

2022

J Med Case Reports

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“…The search was performed for articles published from 1980 to 2021. Additional records from other review articles were also extracted ( 9 – 11 ).…”

Section: Methodsmentioning

confidence: 99%

Risk of CVD Following Radiotherapy for Head and Neck Cancer: An Updated Systematic Review and Meta-Analysis

Lin

Cheng²,

Hsu³

et al. 2022

Front. Oncol.

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BackgroundThe relative risk for cerebrovascular disease (CVD) is increased in patients with head and neck cancer (HNC) treated with radiotherapy (RT). However, the current relative risk for CVD following RT has not been well clarified. The purpose of this study was to analyze the effect of RT and update the risk of CVD following RT in HNC patients through a systematic review and meta-analysis.Material and MethodsWe conducted an online database search and systematic review of observational studies that reported on CVD and extracranial carotid stenosis in patients with HNC who had undergone RT. Articles published in Medline and PubMed from 1980 to 2021 were identified and collected.ResultsOf the forty-seven articles identified from PubMed and forty-four articles identified from 3 systematic reviews, twenty-two studies were included. We found that neck RT was a significant risk factor for CVD (HR 3.97, 95% CI: 2.89-5.45). Patients with HNC treated by RT had an increased OR (7.36, 95% CI: 4.13-13.11) for CVD, and approximately 26% (95% CI: 22%-31%) of HNC patients treated with RT were at risk for CVD with more than 50% reduction in carotid diameter.ConclusionThe risk of CVD is increased in patients with HNC treated by RT, and recent improvements in RT techniques may have contributed to the decreased risk of CVD. These results suggest that regular follow-up and appropriate screening for CVD should be required for patients with HNC.

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“… 11 , 12 , 13 , 14 Similarly, patients with head and neck malignancies receiving RT have a higher incidence of arterial stenosis through the formation of atherosclerotic plaques. 15 , 16 By contrast, RT is not considered as a classical VTE risk factor in cancer because its association with thromboembolic events has been barely evaluated in pan ‐cancer cohorts. In a retrospective sub‐analysis of the RIETE registry, including 9284 patients with active cancer and VTE, there was a two‐fold higher risk for cerebral bleeding in patients treated with RT and concomitant anticoagulation therapy.…”

Section: Introductionmentioning

confidence: 99%

Venous thromboembolism and radiation therapy: The final radiation‐induced thrombosis study analysis

et al. 2022

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Background Thromboembolic events frequently complicate the course of malignancy and represent a major cause of morbidity and mortality in cancer patients. In contrast to chemotherapy and other systemic therapies, little is known about the impact of ionizing radiations on the incidence of venous thromboembolism (VTE) in cancer patients. Methods In the present prospective study, we aimed to investigate the incidence, management, and outcome of VTE in newly diagnosed cancer patients who received curative radiotherapy. Results VTE was found in 8 patients, out of 401 patients at a median time of 80 days after radiotherapy initiation. The incidence rate of VTE at 6 months post‐treatment was 2% (95% CI, 0.9–3.7), with 50% of cases occurring during the radiotherapy course and 50% of cases in patients who received or were receiving chemotherapy. As none of the patients harbored a personal history of VTE, no prophylactic measure was initiated during cancer therapy. Most patients received monotherapy with low‐molecular‐weight heparin and were still on surveillance at the end of the study. No specific clinical risk factor was identified that might systematically indicate the need of thromboprophylaxis in the context of curative radiotherapy. Conclusions Although this pan ‐cancer descriptive study did not relate an increased risk of short‐term thrombosis following ionizing radiation, it provides important insight as a basis for future studies with subcategories of cancer, in order to in fine guide further recommendations in frail patients. Clinical trial registration number NCT02696447.

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Prevalence of carotid stenosis following radiotherapy for head and neck cancer: A systematic review and meta‐analysis

Cited by 27 publications

References 42 publications

Correction of carotid artery stenosis by stent placement ameliorated paroxysmal hypertension after radiation treatment of hypopharyngeal carcinoma: a case report

Correction of carotid artery stenosis by stent placement ameliorated paroxysmal hypertension after radiation treatment of hypopharyngeal carcinoma: a case report

Risk of CVD Following Radiotherapy for Head and Neck Cancer: An Updated Systematic Review and Meta-Analysis

Venous thromboembolism and radiation therapy: The final radiation‐induced thrombosis study analysis

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