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Rosen R, Bodnar M, Randolph J, Bailey CJ, Nickel C, Katsoulakis E, Mifsud M. Risk, prevention, screening and management of carotid artery stenosis in head & neck cancer patients-An evidence based review. Oral Oncol 2024; 156:106876. [PMID: 38908097 DOI: 10.1016/j.oraloncology.2024.106876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 05/12/2024] [Accepted: 05/28/2024] [Indexed: 06/24/2024]
Abstract
Our review aims to clarify the incidence of carotid artery stenosis, risks of development, screening, management, and primary prevention strategies documented in the literature after radiation therapy for head and neck cancers. The high prevalence of carotid stenosis after radiation therapy for head and neck cancers has made surveillance and risk stratification critical. In addition to general cardiovascular risk factors such as smoking, diabetes, and dyslipidemia, risk factors for carotid artery stenosis after head and neck radiation included total plaque score, radiotherapy use and dosage, length of time after radiotherapy, and age greater than 50. Cancer subtype, namely nasopharyngeal cancer, may be correlated with increased risk as well, though contrasting results have been found. Interestingly, however, no significant relationship has been found between radiotherapy dose and stroke risk. Surgical management of post-radiation carotid stenosis is similar to that of stenosis unrelated to radiation, with carotid endarterectomy considered to be the gold standard treatment and carotid artery stenting being an acceptable, less-invasive alternative. Medical management of these patients has not been well-studied, but antiplatelet therapy, statins, and blood pressure control may be beneficial. The mainstay of screening for radiation-induced stenosis has been Doppler ultrasound, with measurement of changes in the intima-media thickness being a primary marker of disease development. A literature review was carried out using the MeSH terms "Carotid Artery Stenosis," "Head and Neck Neoplasms," and "Radiotherapy."
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Affiliation(s)
| | | | - Jackson Randolph
- Georgetown University Medical Center, Department of Otolaryngology-Head and Neck Surgery, USA
| | - Charles J Bailey
- University of South Florida Morsani College of Medicine, Division of Vascular & Endovascular Surgery, USA
| | - Christopher Nickel
- University of South Florida Morsani College of Medicine, Department of Otolaryngology-Head and Neck Surgery, USA
| | - Evangelia Katsoulakis
- University of South Florida Morsani College of Medicine, Department of Radiation Oncology, USA
| | - Matthew Mifsud
- University of South Florida Morsani College of Medicine, Department of Otolaryngology-Head and Neck Surgery, USA.
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2
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Song J, Lan L, Lv Y, Wen Y, Kang M, Wang R. Study on carotid artery stenosis after radiotherapy for nasopharyngeal carcinoma. J Cancer Res Clin Oncol 2024; 150:273. [PMID: 38795230 PMCID: PMC11127852 DOI: 10.1007/s00432-024-05788-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Accepted: 05/07/2024] [Indexed: 05/27/2024]
Abstract
OBJECTIVE This study investigated carotid artery stenosis (CAS) and associated risk factors in patients with nasopharyngeal carcinoma (NPC) post-radiotherapy. MATERIALS AND METHODS The observation group comprised 86 reexamined patients with NPC, divided into Group 1 and Group 2 based on post-radiotherapy duration, alongside 34 newly diagnosed patients with NPC (Group 0). Carotid artery ultrasonography and chi-square analysis were performed. RESULTS Moderate-to-severe vascular abnormalities were exclusively in Group 2. Considering mild vascular abnormalities as the standard, the overall vascular abnormality rates in Group 2 and Group 0 were 65.9% and 41.2%, respectively. In Group 2 and Group 0, the abnormality rates for unilateral carotid artery (UCA), common carotid artery (CCA), internal carotid artery (ICA), and external carotid artery (ECA) were 47.4% and 30.9%, 44.3% and 22.1%, 44.3% and 16.2%, and 39.8% and 5.9%, respectively. Comparing group 1 to group 0, only UCA abnormalities were statistically significant (45.4% vs. 30.9%). Considering moderate-to-severe vascular abnormalities as the standard, Group 2 had higher overall vascular, UCA, CCA, ICA, and ECA abnormality rates compared to Group 0. The age at revisit over 45 years, T stage, and N stage may influence CAS. CONCLUSION Radiation increasing CAS incidence after 3 years. So, regular examinations are recommended to dynamically monitor CAS after 3 years of radiotherapy.
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Affiliation(s)
- JunMei Song
- Department of Radiation Oncology, The First Affiliated Hospital of Guangxi Medical University, Nanning, 530021, Guangxi, China
- Oncology Department, Nanchong Hospital, The Second Clinical Institute of North Sichuan Medical College, Nanchong, 637000, Sichuan, China
- Ministry of Education, Laboratory of Early Prevention and Treatment for Regional High Frequency Tumor (Guangxi Medical University), Nanning, 530021, China
| | - Luo Lan
- Nanning First People's Hospital, Nanning, 530016, Guangxi, China
| | - YuQing Lv
- Department of Radiation Oncology, The First Affiliated Hospital of Guangxi Medical University, Nanning, 530021, Guangxi, China
- Ministry of Education, Laboratory of Early Prevention and Treatment for Regional High Frequency Tumor (Guangxi Medical University), Nanning, 530021, China
| | - YaJing Wen
- Epartment of Radiation Oncology, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
| | - Min Kang
- Department of Radiation Oncology, The First Affiliated Hospital of Guangxi Medical University, Nanning, 530021, Guangxi, China.
- Ministry of Education, Laboratory of Early Prevention and Treatment for Regional High Frequency Tumor (Guangxi Medical University), Nanning, 530021, China.
| | - RenSheng Wang
- Department of Radiation Oncology, The First Affiliated Hospital of Guangxi Medical University, Nanning, 530021, Guangxi, China.
- Ministry of Education, Laboratory of Early Prevention and Treatment for Regional High Frequency Tumor (Guangxi Medical University), Nanning, 530021, China.
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Razavian NB, D'Agostino RB, Shenker RF, Hughes RT. Intensity-Modulated Radiation Therapy for Early-Stage Squamous Cell Carcinoma of the Glottic Larynx: A Systematic Review and Meta-Analysis. Int J Radiat Oncol Biol Phys 2023; 117:652-663. [PMID: 37150263 DOI: 10.1016/j.ijrobp.2023.04.035] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 04/03/2023] [Accepted: 04/29/2023] [Indexed: 05/09/2023]
Abstract
PURPOSE Early-stage squamous cell carcinoma of the glottic larynx is commonly treated with 2-dimensional or 3-dimensional conventional radiation therapy (CRT). Despite its use in other head and neck cancers, intensity-modulated radiation therapy (IMRT) remains controversial in this patient population. METHODS AND MATERIALS A systematic review was performed by querying 3 databases (Pubmed, Embase, Web of Science) for articles published between December 1, 2000 and September 2, 2022. Included studies reported outcomes in at least 10 patients treated with IMRT for early-stage glottic cancer. Data were extracted and reported following PRISMA standards. Pooled outcomes were estimated using random-effects models. Primary outcome was the rate of local failure (LF) following IMRT. Secondary outcomes included rates of regional failure (RF) following IMRT and rates of LF and RF following CRT. RESULTS A total of 15 studies (14 retrospective, 1 prospective) consisting of 2083 patients were identified. IMRT was used in 873 patients (64% T1, 28% T2). Multiple treatment (partial larynx, single vocal cord carotid sparing) and image-guided radiation therapy techniques were used. The pooled crude rate of LF was 7.6% (95% confidence inverval [CI], 3.6%-11.5%) and actuarial LF rates at 3 and 5 years were 6.3% (95% CI, 2.2%-10.3%) and 9.0% (95% CI, 4.4%-13.5%), respectively. The pooled crude rate of RF after IMRT was 1.5% (95% CI, 0.5%-2.5%). On metaregression analysis, increased rate of LF was significantly associated with T2 disease (P < .001) and grade 2 to 3 histology (P < .001). Treatment with CRT was reported in 738 patients (76% T1, 22% T2). Among the studies reporting outcomes of both modalities, there was no significant difference in LF (log odds ratio; P = .12) or RF (log odds ratio; P = .58) between IMRT or CRT. CONCLUSIONS In patients with early-stage glottic cancer, retrospective data suggests local and regional control are similar for patients treated with IMRT and CRT. Additional prospective studies with uniform methods of volume delineation and image guidance are needed to confirm the efficacy of IMRT.
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Affiliation(s)
- Niema B Razavian
- Department of Radiation Oncology, Wake Forest University School of Medicine, Winston Salem, North Carolina
| | - Ralph B D'Agostino
- Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston Salem, North Carolina
| | - Rachel F Shenker
- Department of Radiation Oncology, Duke University School of Medicine, Durham, North Carolina
| | - Ryan T Hughes
- Department of Radiation Oncology, Wake Forest University School of Medicine, Winston Salem, North Carolina.
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Jiang Z, Wu C, Zhao Y, Zhan Q, Wang K, Li Y. Global research trends in immunotherapy for head and neck neoplasms: A scientometric study. Heliyon 2023; 9:e15309. [PMID: 37113789 PMCID: PMC10126860 DOI: 10.1016/j.heliyon.2023.e15309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 04/01/2023] [Accepted: 04/03/2023] [Indexed: 04/29/2023] Open
Abstract
In recent decades, the traditional treatment of head and neck neoplasms has reached a bottleneck with limited improvement in overall survival. Nevertheless, the emerging field of immunotherapy has shown promise. Literature on research into immunotherapy for head and neck neoplasms was retrieved from WoSCC. Citespace was used as a scientometric analysis tool for text mining and visualization of the scientific literature. This analysis included 1915 documents. Recently, the annual number of publications and citations has been growing rapidly. 'Oncology' was the most popular research area. The most dominant institution and country were the University of Pittsburgh and the USA. Ferris RL was not only the most prolific but also the most cited author, demonstrating a strong influence and reputation. Of the ten core journals identified in this field, Cancer Research ranked first. 'Regulatory T cell', 'PD-1' and 'biomarker' were regarded as current hotspots, while 'recurrent' and 'nivolumab' were considered as trending keywords. The most cited reference was Ferris RL (2016). Notably, the front trends and future directions in the field may lie in the clinical practice of combination therapy of immunotherapy plus other therapies, the mechanism of impaired immune surveillance, and the improvement in resistance to immunotherapeutic agents. It is firmly believed that the present scientometric analysis has provided both a macroscopic and microscopic overview of research into immunotherapy for head and neck neoplasms, which will assist researchers and oncologists to better understand this discipline and thus promote further development and policies in this field.
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Affiliation(s)
| | | | | | | | | | - Yi Li
- Corresponding author. Dept. of Head and Neck Oncology, West China Hospital of Stomatology, Sichuan University, No.14, The 3rd section of Renminnan Avenue, Chengdu, Sichuan, 610041, China.
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Liang H, Zhou Y, Xiong W, Zheng S. Impact of radiotherapy for nasopharyngeal carcinoma on carotid stenosis risk: a meta-analysis. Braz J Otorhinolaryngol 2022; 88 Suppl 4:S98-S107. [PMID: 36127266 DOI: 10.1016/j.bjorl.2022.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Accepted: 03/05/2022] [Indexed: 12/14/2022] Open
Abstract
OBJECTS Radiotherapy (RT) serves as the most effective treatment for Nasopharyngeal Carcinoma (NPC) and can cause carotid stenosis. The aim of this study is to assess the impact of RT on carotid stenosis in NPC patients, as well as to explore the risk factors for significant carotid stenosis. METHODS Studies reporting the carotid stenosis in NPC patients who underwent RT were found on PubMed, Embase and Web of Science. Outcomes of our interest included incidence of overall/significant stenosis, Common Carotid Artery (CCA) stenosis, External Carotid Artery (ECA) stenosis, Internal Carotid Artery (ICA) stenosis, and risk factors for significant carotid stenosis. RESULTS Sixteen studies met the inclusion criteria and were included in this meta-analysis. Pooled estimate showed that RT was associated with a significantly higher incidence of overall stenosis (Risk Ratio [RR = 3.53], 95% CI: 2.32‒5.37; p < 0.001) and significant stenosis (RR = 7.06, 95% CI: 3.61‒13.79; p < 0.001) as compared with controls. Moreover, patients treated with RT had a significantly higher risk of stenosis in CCA (RR = 6.87, 95% CI: 4.08‒11.58; p < 0.001), ICA (RR = 3.43, 95% CI: 1.35‒8.73; p = 0.010), ECA (RR = 9.37, 95% CI: 2.06‒42.68; p = 0.004), and ECA/ICA (RR = 2.18, 95% CI: 1.52‒3.13; p < 0.001). Meta-analysis indicated that age (RR = 1.46, 95% CI: 1.05‒2.04; p = 0.024), smoking habit (RR = 1.20, 95% CI: 1.02‒2.78; p = 0.045) and time interval from radiotherapy (RR = 1.56, 95% CI: 1.07‒2.28; p = 0.02) were independent predictors of significant carotid stenosis. CONCLUSION Our results suggested that RT increased the risk of carotid stenosis in patients with NPC. Prevention and control measurements should be made for older NPC patients with longer interval from RT, especially those with smoking habit. LEVEL OF EVIDENCE: 3
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Affiliation(s)
- Huiqing Liang
- Guangzhou University of Chinese Medicine, Shunde Hospital, Department of Imaging, Foshan, China.
| | - Yuanyong Zhou
- Guangzhou University of Chinese Medicine, Shunde Hospital, Department of Imaging, Foshan, China
| | - Wei Xiong
- Guangzhou University of Chinese Medicine, Shunde Hospital, Department of Imaging, Foshan, China
| | - Suimin Zheng
- Guangzhou University of Chinese Medicine, Shunde Hospital, Department of Imaging, Foshan, China
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Lin PY, Cheng PC, Hsu WL, Lo WC, Hsieh CH, Shueng PW, Liao LJ. Risk of CVD Following Radiotherapy for Head and Neck Cancer: An Updated Systematic Review and Meta-Analysis. Front Oncol 2022; 12:820808. [PMID: 35719982 PMCID: PMC9198239 DOI: 10.3389/fonc.2022.820808] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 05/02/2022] [Indexed: 01/17/2023] Open
Abstract
Background The 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 Methods We 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. Results Of 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. Conclusion The 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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Affiliation(s)
- Ping-Yi Lin
- Oral Maxillofacial Surgery, Far Eastern Memorial Hospital, Taipei, Taiwan.,Head and Neck Cancer Surveillance and Research Group, Far Eastern Memorial Hospital, New Taipei, Taiwan
| | - Ping-Chia Cheng
- Head and Neck Cancer Surveillance and Research Group, Far Eastern Memorial Hospital, New Taipei, Taiwan.,Otolaryngology, Far Eastern Memorial Hospital, Taipei, Taiwan
| | - Wan-Lun Hsu
- Genomics Research Center, Academia Sinica, Taipei, Taiwan
| | - Wu-Chia Lo
- Head and Neck Cancer Surveillance and Research Group, Far Eastern Memorial Hospital, New Taipei, Taiwan.,Otolaryngology, Far Eastern Memorial Hospital, Taipei, Taiwan
| | - Chen-Hsi Hsieh
- Head and Neck Cancer Surveillance and Research Group, Far Eastern Memorial Hospital, New Taipei, Taiwan.,Division of Radiation Oncology, Department of Radiology, Far Eastern Memorial Hospital, New Taipei City, Taiwan.,Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Institute of Traditional Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Pei-Wei Shueng
- Head and Neck Cancer Surveillance and Research Group, Far Eastern Memorial Hospital, New Taipei, Taiwan.,Division of Radiation Oncology, Department of Radiology, Far Eastern Memorial Hospital, New Taipei City, Taiwan.,Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Li-Jen Liao
- Head and Neck Cancer Surveillance and Research Group, Far Eastern Memorial Hospital, New Taipei, Taiwan.,Otolaryngology, Far Eastern Memorial Hospital, Taipei, Taiwan.,Department of Electrical Engineering, Yuan Ze University, Taoyuan, Taiwan
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Report on Late Toxicity in Head-and-Neck Tumor Patients with Long Term Survival after Radiochemotherapy. Cancers (Basel) 2021; 13:cancers13174292. [PMID: 34503101 PMCID: PMC8428357 DOI: 10.3390/cancers13174292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 08/06/2021] [Accepted: 08/19/2021] [Indexed: 11/29/2022] Open
Abstract
Simple Summary Regular tumor follow-up care provided by ear-nose-throat specialists ends when patients reach 5-year survival, but radio-toxicity is a lifelong process. In this study, long-term head-and-neck cancer survivors undergoing tumor FU-care exceeding five years were analyzed for late onset symptoms after radio-(chemo-)therapy. Almost one third of these patients developed new radiation associated symptoms beyond the common 5-year tumor follow-up margin. Previous radiotherapy led to a two-fold increase for late-onset new complaints, especially after irradiation of the lymphatic pathways in the neck. These findings underline the need for a life-long tumor-follow-up care for long-term head-and-neck cancer survivors. Abstract Regular tumor follow-up care provided by ear-nose-throat (ENT) specialists ends when patients reach 5-year survival, but radiotoxicity is a continuous lifelong process. In this study, long-term head-and-neck cancer (HNC) survivors undergoing tumor follow-up (FU) care exceeding five years in a certified HNC center of a German university hospital were analyzed for newly diagnosed late sequelae after radio-(chemo-)therapy. Patients diagnosed with squamous cell carcinoma (SCC) of the oral cavity, larynx or oro-/hypopharynx receiving treatment between 1990 and 2010 with a tumor FU care beyond five years were reviewed retrospectively for signs of late sequelae after radio-(chemo-)therapy (R(C)T) including carotid artery stenosis, stenosis of the cranial esophagus, dysphagia, osteoradionecrosis, and secondary malignancies. Long-term survivors that solely received surgical treatment served as control. Of 1143 analyzed patients we identified 407 patients with an overall survival beyond five years, 311 with R(C)T and 96 patients without R(C)T. Furthermore, 221/1143 patients were lost to FU and the mortality rate within the first 5-years was 45%. Moreover, 27.7% of the long-term survivors were diagnosed with new onset late sequelae within the following five years. RT was significantly associated with a two-fold risk increase for newly diagnosed symptoms, especially after RT of the lymphatic pathways (LP) which showed a hazard ratio of 23.3 to develop alterations on the carotid arteries. Additional chemotherapy had no statistical correlation with any late onset toxicity nor did the mode of R(C)T (adjuvant/definitive). Although the validity of this study might be limited due to its retrospective nature and the dependence on the voluntary participation in a prolonged tumor FU, the results nevertheless provide the need to offer and encourage a tumor FU by ENT specialists exceeding the common 5-year margin. This could prevent secondary morbidities and improve quality of life for long-term cancer survivors.
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Valentin ML, Barco S, Studer G, Clemens R, Kreuzpointner R, Sebastian T, Thalhammer C, Kucher N. Prevalence of carotid plaque stenosis after head and neck radiotherapy – an observational study of 156 survivors. VASA 2020; 49:467-473. [DOI: 10.1024/0301-1526/a000896] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Summary: Background: Radiotherapy for head and neck cancer (HNC) represents a well-known predisposing factor for asymptomatic carotid artery lesions and acute cerebrovascular accidents. Our aim is to provide contemporary estimates on the prevalence, severity, and characteristics of carotid artery lesions in HNC survivors. Patients and methods: We prospectively included HNC patients who underwent radiotherapy and were free from the disease at the time of duplex ultrasound evaluation. Patients were re-contacted telephonically and those who agreed to participate were invited for an ambulatory visit when the investigators collected clinical information and performed duplex ultrasound examination based on a predefined protocol. Results: A total of 156 patients were included and underwent duplex ultrasound examination after a mean of 65.2 months from the last session of radiotherapy. A total of 36 patients (23.1%) had normal carotid arteries; mild, non-stenotic lesions were observed in 49.4% (n = 77) of patients; severe stenotic plaques were found in 27.5% (n = 43) of patients. One patient found with an asymptomatic occlusion of the left ICA. The prevalence of major cardiovascular risk factors and high radiation dose increased proportionally with plaque severity. Low echogenicity plaque was found in 59 (37.8%) patients on the right side and 57 (36.5%) on the left side; long segment plaque in 49 (31.4%) patients on the right side and in 47 (30.1%) on the left side; an atypical location of the lesions in 42 (26.9%) patients on the right side and in 48 (30.8%) on the left side. Conclusions: The prevalence of occlusion and severe stenosis after radiotherapy for HNC was very low in our study population. Low echogenicity plaque, long segment plaque, and an atypical location were common findings. Classic cardiovascular risk factors appear to have had a causative role: a routine screening of radiotherapy-treated patients might be necessary only in patients with concomitant cardiovascular risk factors or exposed to high-dose neck radiation.
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Affiliation(s)
| | - Stefano Barco
- Clinic of Angiology, University Hospital Zurich, Zurich, Switzerland
- Center for Thrombosis and Hemostasis, University Medical Center Mainz, Mainz, Germany
| | - Gabriela Studer
- Radiation Oncology, Cantonal Hospital Lucerne, Lucerne, Switzerland
| | - Robert Clemens
- Department of Surgery, Cantonal Hospital Baden, Baden, Switzerland
| | | | - Tim Sebastian
- Clinic of Angiology, University Hospital Zurich, Zurich, Switzerland
| | | | - Nils Kucher
- Clinic of Angiology, University Hospital Zurich, Zurich, Switzerland
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Texakalidis P, Giannopoulos S, Tsouknidas I, Song S, Rivet DJ, Reiter ER, Reavey-Cantwell J. Prevalence of carotid stenosis following radiotherapy for head and neck cancer: A systematic review and meta-analysis. Head Neck 2020; 42:1077-1088. [PMID: 32048781 DOI: 10.1002/hed.26102] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2019] [Revised: 01/08/2020] [Accepted: 01/28/2020] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Radiation to the head and neck is a well-established risk factor for the development of carotid artery stenosis. Our objective was to identify the prevalence, incidence, and degree of carotid stenosis in patients with a history of head and neck irradiation. METHODS This study was performed according to the PRISMA guidelines. A random effects model meta-analysis was conducted. RESULTS Nineteen studies comprising 1479 patients were included. The prevalence of carotid stenosis >50%, >70%, and carotid occlusion was 25% (95% CI: 19%-32%), 12% (95% CI: 7%-17%), and 4% (95% CI: 2%-8%), respectively. The cumulative 12-month incidence of carotid stenosis >50% was 4% (95% CI: 2%-5%), the 24-month was 12% (95% CI: 9%-15%), and the 36-month was 21% (95% CI: 9%-36%). CONCLUSIONS The yearly incidence of carotid stenosis >50% increased every year during the first 3 years following radiotherapy. We propose routine yearly Doppler ultrasound screening beginning 1 year after head and neck radiotherapy.
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Affiliation(s)
- Pavlos Texakalidis
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, Georgia
| | | | - Ioannis Tsouknidas
- Department of Vascular Surgery, Naval and Veterans Hospital of Athens, Athens, Greece
| | - Shiyu Song
- Department of Radiation Oncology, Virginia Commonwealth University, Richmond, Virginia
| | - Dennis J Rivet
- Department of Neurosurgery, Virginia Commonwealth University, Richmond, Virginia
| | - Evan R Reiter
- Department of Otolaryngology-Head and Neck Surgery, Virginia Commonwealth University, Richmond, Virginia
| | - John Reavey-Cantwell
- Department of Neurosurgery, Virginia Commonwealth University, Richmond, Virginia
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Chatterjee S, Mallick I, Chakraborty S, Prasath S, Arunsingh M, Achari RB, Arun B, Nallathambi C, Pattatheyil A, Sen S. Helical Radiotherapy in Early Laryngeal Cancers Could Lead to Excess Local Recurrence: Lessons From a Phase II Prospective Study. Clin Oncol (R Coll Radiol) 2019; 32:e67-e75. [PMID: 31704170 DOI: 10.1016/j.clon.2019.09.048] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 08/06/2019] [Accepted: 08/09/2019] [Indexed: 11/17/2022]
Abstract
AIMS A prospective study was conducted to investigate the feasibility and efficacy of carotid-sparing intensity-modulated radiotherapy (CSIMRT) in early glottic cancers (EGC). MATERIALS AND METHODS Eighteen patients underwent CSIMRT using helical tomotherapy to a dose of 55 Gy/20 fractions/4 weeks. Carotid intimal thickness (CIT) at prespecified carotid levels was measured using B-mode ultrasound at 6, 18 and 36 months. Serial changes in CIT were also measured in a control prospective cohort of 18 patients with head and neck cancers receiving bilateral neck nodal radiation over the same time period (54-60 Gy/30 fraction/6 weeks). The outcomes of 18 patients undergoing CSIMRT were compared against a retrospective consecutive cohort of 41 patients with EGC to confirm comparable local control. RESULTS No significant CIT differences were identified between patients undergoing CSIMRT versus the control group. However, four patients in the CSIMRT group had a local recurrence between 8 and 39 months. In all patients the epicentre of the recurrence was noted at the anterior part of the larynx. The 5-year local recurrence-free survival was 75.1% (95% confidence interval 56.6-99.7%). By contrast, in the group of EGC patients treated without carotid sparing, local recurrence was noted only in a single patient (patient treated with helical tomotherapy) and the 5-year local recurrence-free survival was 97.1% (95% confidence interval 91.8-100%) (Log-rank P = 0.01). CONCLUSION We failed to show the safety of CSIMRT using helical tomotherapy in this population of EGC patients. Use of CSIMRT also did not translate into a substantial reduction in CIT until 36 months. Use of CSIMRT using rotational arc techniques such as helical tomotherapy may be associated with a greater risk of local recurrence due to intrafractional motion interplay effects.
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Affiliation(s)
- S Chatterjee
- Department of Radiation Oncology, Tata Medical Center, Kolkata, India.
| | - I Mallick
- Department of Radiation Oncology, Tata Medical Center, Kolkata, India
| | - S Chakraborty
- Department of Radiation Oncology, Tata Medical Center, Kolkata, India
| | - S Prasath
- Department of Radiation Oncology, Tata Medical Center, Kolkata, India
| | - M Arunsingh
- Department of Radiation Oncology, Tata Medical Center, Kolkata, India
| | - R B Achari
- Department of Radiation Oncology, Tata Medical Center, Kolkata, India
| | - B Arun
- Department of Radiation Oncology, Tata Medical Center, Kolkata, India
| | - C Nallathambi
- Department of Radiation Oncology, Tata Medical Center, Kolkata, India
| | - A Pattatheyil
- Department of Surgical Oncology, Tata Medical Center, Kolkata, India
| | - S Sen
- Department of Radiology, Tata Medical Center, Kolkata, India
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11
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Yu T, Wee CW, Choi N, Wu HG, Kang HC, Park JM, Kim JI, Kim JH, Kwon TK, Chung EJ. Study design and early result of a phase I study of SABR for early-stage glottic cancer. Laryngoscope 2018; 128:2560-2565. [DOI: 10.1002/lary.27226] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Revised: 03/06/2018] [Accepted: 03/20/2018] [Indexed: 01/08/2023]
Affiliation(s)
- Tosol Yu
- Department of Radiation Oncology; Seoul National University College of Medicine; Seoul Republic of Korea
| | - Chan Woo Wee
- Department of Radiation Oncology; Seoul National University College of Medicine; Seoul Republic of Korea
| | - Noorie Choi
- Department of Radiation Oncology; Seoul National University College of Medicine; Seoul Republic of Korea
| | - Hong-Gyun Wu
- Institute of Radiation Medicine, Medical Research Center; Seoul National University; Seoul Republic of Korea
- Department of Radiation Oncology; Seoul National University College of Medicine; Seoul Republic of Korea
- Cancer Research Institution; Seoul National University College of Medicine; Seoul Republic of Korea
| | - Hyun-Cheol Kang
- Institute of Radiation Medicine, Medical Research Center; Seoul National University; Seoul Republic of Korea
- Department of Radiation Oncology; Seoul National University College of Medicine; Seoul Republic of Korea
- Cancer Research Institution; Seoul National University College of Medicine; Seoul Republic of Korea
| | - Jong Min Park
- Institute of Radiation Medicine, Medical Research Center; Seoul National University; Seoul Republic of Korea
- Department of Radiation Oncology; Seoul National University College of Medicine; Seoul Republic of Korea
- Cancer Research Institution; Seoul National University College of Medicine; Seoul Republic of Korea
| | - Jung-In Kim
- Institute of Radiation Medicine, Medical Research Center; Seoul National University; Seoul Republic of Korea
- Department of Radiation Oncology; Seoul National University College of Medicine; Seoul Republic of Korea
- Cancer Research Institution; Seoul National University College of Medicine; Seoul Republic of Korea
| | - Jin Ho Kim
- Institute of Radiation Medicine, Medical Research Center; Seoul National University; Seoul Republic of Korea
- Department of Radiation Oncology; Seoul National University College of Medicine; Seoul Republic of Korea
- Cancer Research Institution; Seoul National University College of Medicine; Seoul Republic of Korea
| | - Tack-Kyun Kwon
- Department of Otorhinolaryngology-Head and Neck Surgery; Seoul National University College of Medicine; Seoul Republic of Korea
| | - Eun-Jae Chung
- Department of Otorhinolaryngology-Head and Neck Surgery; Seoul National University College of Medicine; Seoul Republic of Korea
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12
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Fernández-Alvarez V, López F, Suárez C, Strojan P, Eisbruch A, Silver CE, Mendenhall WM, Langendijk JA, Rinaldo A, Lee AWM, Beitler JJ, Smee R, Alvarez J, Ferlito A. Radiation-induced carotid artery lesions. Strahlenther Onkol 2018; 194:699-710. [DOI: 10.1007/s00066-018-1304-4] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Accepted: 04/10/2018] [Indexed: 11/24/2022]
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13
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Ward MC, Pham YD, Kotecha R, Zakem SJ, Murray E, Greskovich JF. Clinical and dosimetric implications of intensity-modulated radiotherapy for early-stage glottic carcinoma. Med Dosim 2015; 41:64-9. [PMID: 26553472 DOI: 10.1016/j.meddos.2015.08.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2015] [Revised: 06/19/2015] [Accepted: 08/31/2015] [Indexed: 11/19/2022]
Abstract
Conventional parallel-opposed radiotherapy (PORT) is the established standard technique for early-stage glottic carcinoma. However, case reports have reported the utility of intensity-modulated radiotherapy (IMRT) and volumetric-modulated arc therapy (VMAT) with or without image guidance (image-guided radiotherapy, IGRT) in select patients. The proposed advantages of IMRT/VMAT include sparing of the carotid artery, thyroid gland, and the remaining functional larynx, although these benefits remain unclear. The following case study presents a patient with multiple vascular comorbidities treated with VMAT for early-stage glottic carcinoma. A detailed explanation of the corresponding treatment details, dose-volume histogram (DVH) analysis, and a review of the relevant literature are provided. Conventional PORT remains the standard of care for early-stage glottic carcinoma. IMRT or VMAT may be beneficial for select patients, although great care is necessary to avoid a geographical miss. Clinical data supporting the benefit of CRT are lacking. Therefore, these techniques should be used with caution and only in selected patients.
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Affiliation(s)
| | - Yvonne D Pham
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland, OH
| | - Rupesh Kotecha
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland, OH
| | - Sara J Zakem
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland, OH
| | - Eric Murray
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland, OH
| | - John F Greskovich
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland, OH
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Anzidei M, Suri JS, Saba L, Sanfilippo R, Laddeo G, Montisci R, Piga M, Argiolas GM, Raz E. Longitudinal assessment of carotid atherosclerosis after Radiation Therapy using Computed Tomography: A case control Study. Eur Radiol 2015; 26:72-8. [PMID: 26408306 DOI: 10.1007/s00330-015-3753-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Revised: 02/04/2015] [Accepted: 03/30/2015] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To study the carotid artery plaque composition and its volume changes in a group of patients at baseline and 2 years after head and neck radiation therapy treatment (HNXRT). METHODS In this retrospective study, 62 patients (41 males; mean age 63 years; range 52-81) who underwent HNXRT and 40 patients (24 males; mean age 65) who underwent surgical resection of neoplasm and did not undergo HNXRT were assessed, with 2-year follow-up. The carotid artery plaque volumes, as well as the volume of the sub-components (fatty-mixed-calcified), were semiautomatically quantified. Mann-Whitney and Wilcoxon tests were used to test the hypothesis. RESULTS In the HNXRT group, there was a statistically significant increase in the total volume of the carotid artery plaques (from 533 to 746 mm(3); p = 0.001), in the fatty plaques (103 vs. 202 mm(3); p = 0.001) and mixed plaque component volume (328 vs. 419 mm(3); p = 0.034). A statistically significant variation (from 21.8 % to 27.6 %) in the percentage of the fatty tissue was found. CONCLUSIONS Results of this preliminary study suggest that HNXRT promotes increased carotid artery plaque volume, particularly the fatty plaque component. KEY POINTS HNXRT increases carotid plaque volume. Plaque volume increase is mainly due to increase.in fatty plaque component. Patients who undergo HNXRT have a progression of carotid artery disease.
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Affiliation(s)
- Michele Anzidei
- Department of Radiology, University of Rome la Sapienza, Rome, Italy
| | - Jasjit S Suri
- Monitoring and Diagnostic Division, AtheroPoint(TM) LLC, Roseville, CA, USA / Point of Care Devices, Global Biomedical Technologies, Inc., CA, USA / Electrical Engineering Department (Affl.), University of Idaho, Moscow, ID, USA
| | - Luca Saba
- Department of Radiology, Azienda Ospedaliero Universitaria (A.O.U.), di Cagliari, Polo di Monserrato, s.s. 554 Monserrato, Cagliari, 09045, Italy.
| | - Roberto Sanfilippo
- Department of Vascular Surgery, Azienda Ospedaliero Universitaria (A.O.U.), di Cagliari, Polo di Monserrato, s.s. 554 Monserrato, Cagliari, 09045, Italy
| | - Giancarlo Laddeo
- Department of Radiology, New York University Langone Medical Center, New York, NY, 10016, USA
| | - Roberto Montisci
- Department of Vascular Surgery, Azienda Ospedaliero Universitaria (A.O.U.), di Cagliari, Polo di Monserrato, s.s. 554 Monserrato, Cagliari, 09045, Italy
| | - Mario Piga
- Monitoring and Diagnostic Division, AtheroPoint(TM) LLC, Roseville, CA, USA / Point of Care Devices, Global Biomedical Technologies, Inc., CA, USA / Electrical Engineering Department (Affl.), University of Idaho, Moscow, ID, USA
| | | | - Eytan Raz
- Department of Radiology, University of Rome la Sapienza, Rome, Italy.,Department of Radiology, New York University Langone Medical Center, New York, NY, 10016, USA
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15
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Zhou L, Xing P, Chen Y, Xu X, Shen J, Lu X. Carotid and vertebral artery stenosis evaluated by contrast-enhanced MR angiography in nasopharyngeal carcinoma patients after radiotherapy: a prospective cohort study. Br J Radiol 2015; 88:20150175. [PMID: 25875781 DOI: 10.1259/bjr.20150175] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To investigate the incidence of carotid artery (CA) and vertebral artery (VA) stenosis by contrast-enhanced MR angiography (CE-MRA) in patients with nasopharyngeal carcinoma (NPC) after radiotherapy. METHODS 72 patients with NPC after radiotherapy more than 3 years ago were recruited as irradiation group to investigate the incidence and degree of CA and VA stenosis by CE-MRA. The results were compared with those of the control group, which comprised 50 newly diagnosed patients with NPC who had not received radiotherapy. RESULTS There was a higher incidence of CA and VA stenosis in the irradiation group than in the control group in terms of patient number as well as vessel involvement. The incidence of significant (>50%) CA and VA stenosis, except for the basilar artery, was also higher in the irradiation group than in the control group. The most commonly detected stenosis in the irradiation group was found in the internal CA (ICA) and VA, followed by the external CA and common CA (CCA). CCA and/or ICA (CCA/ICA) stenosis was present in 67 (93.1%) of 72 patients, with 27 (37.5%) patients having significant CCA/ICA stenosis. The statistical analysis demonstrated that age at receiving CE-MRA scanning and time interval from radiotherapy were the independent predictors of significant CCA/ICA stenosis. CONCLUSION The CE-MRA scanning results showed that the incidence of stenosis seems to exist in a wider range of CAs and VAs in the patients with NPC after radiotherapy than in the patients who had not received radiotherapy, and the incidence of significant CCA/ICA stenosis is higher in patients with older age and longer interval from radiotherapy. ADVANCES IN KNOWLEDGE Radiation-induced CA and VA stenosis exists widely in patients with NPC after radiotherapy, and its prevalence is more common in patients with older age and longer interval from radiotherapy.
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Affiliation(s)
- L Zhou
- 1 Department of Radiology, The Second Affiliated Hospital of Soochow University, Suzhou, China
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Taki J, Tokime T, Matsumoto A, Akiyama Y. Vascular Reconstruction for Radiation-induced Bilateral Internal Carotid Artery Occlusion and Unilateral External Carotid Artery Stenosis by a Combination of Surgical and Endovascular Method: Case Report. NMC Case Rep J 2014; 2:16-20. [PMID: 28663956 PMCID: PMC5364928 DOI: 10.2176/nmccrj.2014-0154] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2014] [Accepted: 07/09/2014] [Indexed: 11/20/2022] Open
Abstract
We present a case of a 63-year-old male presenting with right hemiparesis and diagnosed as cerebral infarction. He had a previous history of left pharyngeal carcinoma, which was treated by radial dissection and radiation therapy 10 years before. Magnetic resonance imaging (MRI) showed multiple cerebral infarction in the bilateral cerebral hemisphere, predominantly on the left. Cerebral angiography showed occlusion of bilateral internal carotid arteries and severe stenosis at the orifice of the left external carotid artery (ECA). Single photon emission tomography (SPECT) showed reduced cerebral blood flow and decreased cerebral vascular reserve in the bilateral anterior cerebral artery and left middle cerebral artery territories. He was successfully treated by a combination of carotid stenting for the left ECA and left superficial temporal artery-middle cerebral artery (STA-MCA) anastomosis. He did not have further ischemic symptom for more than 2 years. Radiation-induced carotid vasculopathy often involves multiple arteries and treatment is often complex and difficult. Safer and less invasive treatment strategy should be considered using both endovascular and direct surgery.
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Affiliation(s)
- Junya Taki
- Department of Neurosurgery, Tenri Hospital, Tenri, Nara
| | - Tomoo Tokime
- Department of Neurosurgery, Tenri Hospital, Tenri, Nara
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Bashar K, Healy D, Clarke-Moloney M, Burke P, Kavanagh E, Walsh SR. Effects of neck radiation therapy on extra-cranial carotid arteries atherosclerosis disease prevalence: systematic review and a meta-analysis. PLoS One 2014; 9:e110389. [PMID: 25329500 PMCID: PMC4199672 DOI: 10.1371/journal.pone.0110389] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2014] [Accepted: 09/12/2014] [Indexed: 11/19/2022] Open
Abstract
Introduction Radiation arteritis following neck irradiation as a treatment for head and neck malignancy has been well documented. The long-term sequelae of radiation exposure of the carotid arteries may take years to manifest clinically, and extra-cranial carotid artery (ECCA) stenosis is a well-recognised vascular complication. These carotid lesions should not be regarded as benign and should be treated in the same manner as standard carotid stenosis. Previous studies have noted increased cerebrovascular events such as stroke in this cohort of patients because of high-grade symptomatic carotid stenosis resulting in emboli. Aim To evaluate the effect of radiation therapy on ECCA atherosclerosis progression. Methods Online search for case-control studies and randomised clinical trials that reported on stenosis in extra-cranial carotid arteries in patients with neck malignancies who received radiation therapy (RT) comparing them to patients with neck malignancies who did not receive RT. Results Eight studies were included in the final analysis with total of 1070 patients – 596 received RT compared to 474 in the control group. There was statistically significant difference in overall stenosis rate (Pooled risk ratio = 4.38 [2.98, 6.45], P = 0.00001) and severe stenosis (Pooled risk ratio = 7.51 [2.78, 20.32], P <0.0001), both being higher in the RT group. Pooled analysis of the five studies that reported on mild stenosis also showed significant difference (Pooled risk ratio = 2.74 [1.75, 4.30], 95% CI, P = 0.0001). Conclusion The incidence of severe ECCA stenosis is higher among patients who received RT for neck malignancies. Those patients should be closely monitored and screening programs should be considered in all patients who receive neck RT.
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Affiliation(s)
- Khalid Bashar
- Department of Vascular Surgery, University Hospital Limerick (UHL), Limerick, County Limerick, Ireland
- * E-mail:
| | - Donagh Healy
- Department of Vascular Surgery, University Hospital Limerick (UHL), Limerick, County Limerick, Ireland
| | - Mary Clarke-Moloney
- Department of Vascular Surgery, University Hospital Limerick (UHL), Limerick, County Limerick, Ireland
| | - Paul Burke
- Department of Vascular Surgery, University Hospital Limerick (UHL), Limerick, County Limerick, Ireland
| | - Eamon Kavanagh
- Department of Vascular Surgery, University Hospital Limerick (UHL), Limerick, County Limerick, Ireland
| | - Stewart-Redmond Walsh
- Department of surgery, National University of Ireland Galway (NUIG), Galway, County Galway, Ireland
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Janssen S, Glanzmann C, Huber G, Studer G. Risk-adapted partial larynx and/or carotid artery sparing modulated radiation therapy of glottic cancer. Radiat Oncol 2014; 9:136. [PMID: 24923417 PMCID: PMC4094917 DOI: 10.1186/1748-717x-9-136] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2014] [Accepted: 05/31/2014] [Indexed: 01/05/2023] Open
Abstract
Background To evaluate outcome in patients with glottic cancer treated with intensity-modulated radiotherapy (IMRT) and to show effectiveness of partial laryngeal- and/or carotid artery sparing in low to intermediate risk tumors. Study design Retrospective analysis. Material and methods From 01/2004 to 03/2013 77 consecutive patients presenting with glottic cancer were treated in our department with IMRT as definitive treatment. T-stages distributed as follows: T1: n = 17, T2: n = 24, T3: n = 15, T4: n = 13 and recurrences: 8 patients. Concomitant systemic therapy was applied in 39 patients consisting of either cisplatin or cetuximab. Results Mean/median follow-up (FU) time was 32.2/28 months (range: 4–98.7). Three year local control (LC), ultimate LRC and laryngectomy free survival rate was 77%, 92% and 80%, respectively. Three year overall survival of the entire cohort was 81%. Three year local control for T1/T2, T3/T4, and recurred tumors was 95%, 65%, and 38%, respectively. Three year overall survival was 86% for T1-4 stages, 55% for recurred disease, respectively. Partial laryngeal/carotid artery sparing was performed in all T1 patients (n = 17) and 17/22 T2N0 patients. Rate of late sequels was low. Conclusion IMRT for glottic cancer shows high control rates. In low to intermediate risk tumors an individualized treatment volume with partial larynx +/- carotid artery sparing is effective and holds the potential to reduce long term toxicity. The therapeutic outcome was not compromised.
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Affiliation(s)
| | | | | | - Gabriela Studer
- Department of Radiation Oncology, University Hospital Zurich, Rämistrasse 100, Zürich CH-8091, Switzerland.
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Lyons AJ, Nixon I, Papadopoulou D, Crichton S. Can we predict which patients are likely to develop severe complications following reconstruction for osteoradionecrosis? Br J Oral Maxillofac Surg 2013; 51:707-13. [PMID: 24176184 DOI: 10.1016/j.bjoms.2013.08.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2013] [Accepted: 08/29/2013] [Indexed: 11/17/2022]
Abstract
High morbidity has been reported for free vascularised reconstruction for osteoradionecrosis (ORN) and there are no apparent risk factors. A single nucleotide polymorphism in the transforming growth factor beta 1 gene (TGF-β1) has been implicated in the cause of ORN and may also predict these complications. We studied a series of 30 consecutive patients who had had reconstruction for severe ORN with free tissue transfer in relation to their outcomes and complications for a number of risk factors including TFG-β1 genotype, age, sex, comorbidities, site and stage of tumour, type of initial operation, and dose of radiotherapy or chemoradiotherapy. Two patients died and 2 flaps failed. Using the Clavien-Dindo classification, 16 patients developed grade III complications and 6 grade II. Median (IQR) duration of inpatient stay was 19.5 (12-25) days and the median (IQR) duration of outpatient treatment was 6 (4-11) weeks. No specific risk factors for postoperative complications were identified. In view of the severity and unpredictability of the complications, careful preoperative counselling of patients is essential.
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Affiliation(s)
- Andrew J Lyons
- Head and Neck Unit, Guy's and St. Thomas' Hospital NHS Foundation Trust, London, United Kingdom.
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What is in this issue. Clin Otolaryngol 2013. [DOI: 10.1111/coa.12080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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