Abstract
PurposePost-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.MethodsThe 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.ResultsRadiotherapy 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.ConclusionRadiotherapists 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.
Highlights
Radiotherapy is an integral part of head and neck squamous cell cancer (HNSCC) therapy
The study examined the impact of head and neck RT on carotid artery intima-media thickness (IMT)
The correlation between IMT and radiotherapy was comparable to established cardiovascular risk factors
Summary
Radiotherapy is an integral part of head and neck squamous cell cancer (HNSCC) therapy. For human papillomavirus-related oropharyngeal cancer, high dose radiotherapy (RT) enables 5-year overall survival rates of up to 95% [1,2,3,4]. The improving outcome and lack of dose de-escalation strategies put the patients at risk for. To stratify the risk of stroke in irradiated patients, the intima-media thickness (IMT) may be a valuable biomarker [7, 15]. Ultrasonographic IMT is an early indicator of carotid artery damage and accessible during routine cancer-aftercare [7, 10, 12]. Combining IMT measurement with cardiovascular risk scores (e.g. Framingham Risk Score) may improve the prevention of severe adverse complications after neck RT [5]
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