Radiation-induced carotid artery lesions

Fernández-Álvarez, Verónica; López, Fernando; Suárez, Carlos; Strojan, Primož; Eisbruch, Avraham; Silver, Carl E.; Mendenhall, William M.; Langendijk, Johannes A.; Rinaldo, Alessandra; Lee, Anne W.M.; Beitler, Jonathan J.; Smee, Robert; Álvarez, J. Cerviño; Ferlito, Alfio

doi:10.1007/s00066-018-1304-4

Cited by 55 publications

(43 citation statements)

References 103 publications

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“…Treatment of stenosis caused by RT is usually by placing a stent. Other methods include removal of the blockage (endarterectomy), and prosthetic carotid bypass grafting [44]. RT can damage the CA baroreceptors.…”

Section: Damage To Neck Structuresmentioning

confidence: 99%

Late side effects of radiation treatment for head and neck cancer

Brook

2020

Radiat Oncol J

169

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Radiation therapy (RT) is often used to treat head and neck cancer (HNC) [1]. RT can damage blood vessels that nourish muscles, nerves, and bones resulting in a progressive "radiation fibrosis syndrome", which causes a variety of complications [2]. The likelihood and severity of complications depends on a number of factors, including the total dose of radiation delivered, over what time it was delivered and what parts of the head and neck received radiation. The side effects of RT for HNC are divided into early (acute) and long-term (chronic) effects [3]. Early side effects occur during the course of therapy and during the immediate post therapy period (approximately 2-3 weeks after the completion of a course of RT). Late effects can manifest any time thereafter, from weeks to years later [4]. Patients are usually most bothered by the early effects of RT, although these will generally resolve over time. Knowledge of the ra-Patients undergoing radiation therapy for head and neck cancer (HNC) experience significant early and long-term side effects. The likelihood and severity of complications depends on a number of factors, including the total dose of radiation delivered, over what time it was delivered and what parts of the head and neck received radiation. Late side effects include: permanent loss of saliva; osteoradionecrosis; radiation recall myositis, pharyngoesophageal stenosis; dental caries; oral cavity necrosis; fibrosis; impaired wound healing; skin changes and skin cancer; lymphedema; hypothyroidism, hyperparathyroidism, lightheadedness, dizziness and headaches; secondary cancer; and eye, ear, neurological and neck structures damage. Patients who undergo radiotherapy for nasopharyngeal carcinoma tend to suffer from chronic sinusitis. These side effects present difficult challenges to the patients and their caregivers and require lifelong strategies to alleviate their deleterious effect on basic life functions and on the quality of life. This review presents these side effects and their management.

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Section: Damage To Neck Structuresmentioning

confidence: 99%

Late side effects of radiation treatment for head and neck cancer

Brook

2020

Radiat Oncol J

169

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“…Head and neck cancer RT cause carotid artery damage that results in increased IMT, stenosis and enhanced risk of stroke [5,8,10,11,14]. However, the effect of the tumour side boost (> 60 Gy) remains unclear.…”

Section: Discussionmentioning

confidence: 99%

“…Pathogenesis of RT vasculopathy includes acute effects such as platelet aggregation and inflammation followed by long-term effects such as fibrosis [7,8,10]. Stenosis emerges years after treatment, but the onset of the IMT change remains controversial.…”

Section: Et Al Found a Linear Correlation Betweenmentioning

confidence: 99%

“…However, the improving outcome and lack of dose de-escalation strategies put the patients at risk for long-term RT-related complications [5,6]. Post-RT vasculopathy is a common side-effect causing fibrosis (damage to vasa vasorum), platelet aggregation (damage to endothelium), and foam-cell formation (inflammation) [7][8][9][10]. Post-RT vasculopathy results in a severe form of atherosclerosis and significantly increases the cerebrovascular risk [7,8,[10][11][12][13][14].…”

Section: Introductionmentioning

confidence: 99%

“…Post-RT vasculopathy is a common side-effect causing fibrosis (damage to vasa vasorum), platelet aggregation (damage to endothelium), and foam-cell formation (inflammation) [7][8][9][10]. Post-RT vasculopathy results in a severe form of atherosclerosis and significantly increases the cerebrovascular risk [7,8,[10][11][12][13][14]. Carotid artery stenosis results in 18-40% and the relative risk of stroke increases by five compared to healthy controls and non-irradiated cancer patients [5,10,11,14].…”

Section: Introductionmentioning

confidence: 99%

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Screening for irradiation vasculopathy by intima-media thickness sonography in head and neck cancer patients

Strüder

Hellwig

Rennau

et al. 2020

Eur Arch Otorhinolaryngol

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Purpose Post-irradiation vasculopathy is a severe form of atherosclerosis and affects the prognosis of head and neck cancer survivors. Sonographic intima-media thickness (IMT) precedes stenosis, plaque formation, and cerebrovascular events. Therefore, IMT may be a valuable screening marker for post-irradiation toxicity. However, the critical irradiation dose and the onset of IMT increase remain unclear. Methods The cross-sectional study analysed the carotid artery IMT in 96 irradiated patients and 41 controls regarding irradiation dose, post-irradiation-interval, and cardiovascular risk factors. Distinct irradiation doses to the tumour side and the contralateral hemineck enabled detection of dose depended effects within one patient and control of risk factors. Results Radiotherapy caused a dose-dependent increase in IMT. The toxicity did not have saturation effects for > 60 Gy. The IMT increase occurred in short-term following radiotherapy and the risk for a pathological value (> 0.9 mm) rose significantly. The correlation between IMT and radiotherapy was comparable to established cardiovascular risk factors. Conclusion Radiotherapists should consider the additional toxicity of high doses for non-metastatic head and neck cancer. If neck metastases require radiotherapy with boost, IMT measurement is suitable for early detection of carotid artery damage.

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