Accelerated Risk of Premature Ischemic Stroke in 5-Year Survivors of Nasopharyngeal Carcinoma

Abstract

Background Research on cancer survivorship associated with nasopharyngeal carcinoma (NPC) is rare. We aimed to elucidate the risk of ischemic stroke in 5‐year survivors of NPC following radiotherapy (RT) or concurrent chemoradiation therapy (CCRT). Subjects, Materials, and Methods NPC survivors, defined as those who survived longer than 5 years after diagnosis, were identified and matched at a 1:5 ratio with normal controls from the Longitudinal Health Insurance Database 2005 of Taiwan. The stratified Cox regression models were used to access the risk of ischemic stroke, with adjustment for age, treatment modality, comorbidities, and socioeconomic characteristics. Results From 2000 to 2005, a total of 3,016 NPC survivors who had received RT (n = 959) or CCRT (n = 2,057) and 15,080 controls were matched for age, sex, income, and urbanization level. The risk of ischemic stroke was significantly higher in the NPC survivor cohort than in the control cohort. Stroke was positively related to death. Moreover, the age onset of stroke for NPC survivors was 10 years earlier than that for the general population. Conclusion Not only was the stroke risk in NPC survivors higher than that in the general population, but the onset age was also 10 years earlier. Future survivorship care should include ischemic stroke as a late complication, for its proper prevention and management. Implications for Practice Nasopharyngeal carcinoma (NPC) is endemic in Taiwan, and its 5‐year survival is 65.2%. With the increased 5‐year cancer survivors, survivorship has become an important issue. However, research on NPC survivorship is very rare. To the authors’ knowledge, this is the first population‐based study on long‐term NPC survivors. This study's results indicated that not only was the risk of ischemic stroke in NPC survivors at least triple that of the general population, but the onset age was also 10 years earlier. These results may provide solid evidence that survivorship care guidelines should include stroke as a late complication in 5‐year NPC survivors, for its proper prevention and management.

Radiotherapy Is Associated with an Accelerated Risk of Ischemic Stroke in Oral Cavity Cancer Survivors after Primary Surgery

“…These results provide evidence that young OCC survivors (<50 years old) should not be exempt from stroke surveillance. Similar findings have been reported in nasopharyngeal carcinoma survivors, in whom radiation is the main treatment modality [7][8][9].…”

“…Due to advances in surgical and radiation technology, the number of male OCC survivors is expected to increase from around 250,000 people in 2020 to over 300,000 in 2030 [3]. Previous studies have suggested that there may be an increased risk of stroke in patients with head and neck cancers, and have proposed that radiation may cause this long-term complication [4][5][6][7][8][9]. However, head and neck cancer is a heterogeneous disease, and these studies have included all patients from diagnosis rather than specifically focusing on long-term survivors.…”

Head and neck cancer survivorship consensus statement from the American Head and Neck Society

“…24 Increased non-cancer-related mortality in >5-year survivors is multifactorial but appears to be largely driven by cardiovascular disease (i.e., exacerbation of hypertension, increased risk of stroke, and myocardial infarction). 25 A Surveillance, Epidemiology and End Results (SEER) population-based study demonstrated a high comorbidity burden in HNC patients at the time of diagnosis which increased significantly at 5 years post-diagnosis; this trend was measured in both HPV-related and HPV-unrelated disease variants. 26 In addition to a higher rate of medical problems, HNC survivors have also been shown to demonstrate a nearly twofold risk (adjusted rate ratio, 1.97) of suicide over time compared to patients with other types of cancers.…”

Radiotherapy Is Associated with an Accelerated Risk of Carotid Atherosclerosis in Patients with Nasopharyngeal Carcinoma: A Nine-Year Prospective Follow-Up Study

“…Nasopharyngeal carcinoma (NPC) is characterized by its unique geographic distribution in southeastern China and Taiwan, and both environmental factors and genetic traits contribute to its development [ 1 ]. Concurrent chemoradiation therapy (CCRT) prolongs survival in patients with NPC [ 2 , 3 ]. With the increased number of five-year cancer survivors, survivorship has become an important issue [ 3 , 4 ].…”