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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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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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