Carotid stenosis prevalence after radiotherapy in nasopharyngeal carcinoma: A meta-analysis

Liao, Wang; Zheng, Yuqiu; Bi, Shangqing; Zhang, Bei; Xiong, Ying; Li, Yi; Fang, Wenli; Xiao, Shifu; Yang, Liguo; Anderson, Thea; Li, Jun

doi:10.1016/j.radonc.2018.11.013

Cited by 32 publications

(25 citation statements)

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“…In addition, the meta-analysis of Ho et al (27) demonstrated that skip metastasis of lymph nodes is relatively rare, with an incidence ranging from 0.2 to 7.9%. More importantly, widerange irradiation of the whole neck could result in dysfunction in surrounding critical organs and tissues and affect the patient's long-term quality of life (8)(9)(10)(11)(12). Therefore, it is logical to question whether radiotherapy covering the entire neck is necessary.…”

Section: Discussionmentioning

confidence: 99%

“…Given the relatively high incidence of cervical lymph node metastasis in NPC (2,3), in many research protocols, irradiation of the entire bilateral cervical lymphatic drainage area is thought to be warranted irrespective of the lymph node status (4-7). However, extensive neck irradiation may lead to severe late toxicities such as neck subcutaneous fibrosis, hypothyroidism, and carotid stenosis, thus adversely influencing the quality of life of long-term survivors (8)(9)(10)(11)(12). Therefore, it is essential to investigate whether omitting the irradiation of certain neck areas would be feasible.…”

Section: Introductionmentioning

confidence: 99%

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Contralateral Lower Neck Sparing Radiotherapy in Stage N1 Nasopharyngeal Carcinoma: Long-Term Survival Outcomes and Late Toxicities

et al. 2021

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PurposeTo explore the feasibility of contralateral lower neck sparing radiotherapy for patients with stage N1 nasopharyngeal carcinoma (NPC) by analyzing long-term survival outcomes and late toxicities.MethodsData of patients with stage N1 NPC who were treated with contralateral lower neck sparing radiotherapy between January 2013 and December 2015 were analyzed. These patients were all staged by magnetic resonance imaging (MRI), and all received irradiation to the upper neck (levels II, III, and Va) bilaterally along with ipsilateral levels IV and Vb, without irradiation of the contralateral lower neck. Treatment outcomes, regional failure patterns, and late toxicities were examined.ResultsA total of 275 eligible patients with stage N1 NPC were included in the present study. The median follow-up period was 62 months (range, 3–93 months). The 5-year overall survival (OS), distant metastasis-free survival (DMFS), local recurrence-free survival (LRFS), regional recurrence-free survival (RRFS), locoregional recurrence-free survival (LRRFS), and progression-free survival (PFS) rates were 90.5, 91.3, 94.7, 95.3, 91.2, and 81.7%, respectively. A total of 13 patients (4.7%) developed regional recurrence, all of which occurred in the field and not out of the field. Among 254 patients with available data on late toxicities, the most common late toxicity was xerostomia. No late injuries occurred in the carotid arteries, brachial plexus, or spinal cord. In addition to one case (0.4%) of neck fibrosis and three cases (1.2%) of hearing loss, there were no other grade 3–4 late toxicities observed.ConclusionsContralateral lower neck sparing radiotherapy would be safe and feasible for patients with stage N1 NPC, with the potential to improve the long-term quality of life of patients.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Contralateral Lower Neck Sparing Radiotherapy in Stage N1 Nasopharyngeal Carcinoma: Long-Term Survival Outcomes and Late Toxicities

et al. 2021

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“…Postradiation patients showed a statistically significant higher incidence of overall stenosis (pooled risk ratio ¼ 4.17 [2.44, 7.10], p < 0.00001) and an even greater incidence of significant stenosis (50% or more; pooled risk ratio ¼ 8.72 [3.53, 21.55], p < 0.00001). 50…”

Section: Postradiation Carotid Arteritismentioning

confidence: 99%

Imaging of nonatheromatous carotid artery disease

Montes

Romero

2021

Clinical and Translational Neuroscience

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Imaging diagnosis of nonatheromatous carotid artery disease is challenging due to its low prevalence in contrast to that of atheromatous disease. Congenital anomalies are frequently discovered incidentally, as the chronicity of these conditions allows for compensatory flow development. The inflammatory conditions typically present with nonspecific courses, and a high clinical suspicion along with timely imaging evaluation can guide the diagnosis. Carotid dissection is the result of a partial disruption of the arterial wall and can be seen in previously healthy patients, in patients with underlying noninflammatory arteriopathies or trauma. Traumatic injuries to the carotid artery may occur under many different conditions and mechanisms and timely recognition of high-risk patients improves patient outcomes. Although free-floating thrombi (FFT) formation is typically seen with atherosclerotic plaque rupture, different conditions may also predispose to FFT. In this review article, we study the different imaging features of nonatheromatous carotid artery disease using ultrasonography, computed tomography angiography, magnetic resonance angiography, and digital subtraction angiogram.

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“…Therefore, radiation-induced carotid artery disease has become an important clinical issue in patients with HNSCC. There are several studies demonstrating that patients with head and neck malignancies receiving RT have a higher incidence of carotid stenosis, and experience neurological events more often than the average general population [2], [6], [7], [8], [9].…”

Section: Introductionmentioning

confidence: 99%

Management of Radiation Induced Carotid Stenosis in Head and Neck Cancer

Trojanowski

Sojka

Trojanowska

et al. 2019

Translational Oncology

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OBJECTIVES: Presentation of radiation-induced lesions in carotid arteries of patients with head and neck squamous cell carcinoma (HNSCC) and the evaluation of the effectiveness of endovascular treatment of symptomatic stenoses. MATERIALS AND METHODS: We retrospectively analyzed 26 patients who underwent surgery and subsequently cervical radiotherapy (RT) for HNSCC, focusing on radiation-induced vascular disease in neck arteries—from the latency period to the occurrence of neurological events—and the endovascular treatment of the internal carotid artery (ICA) and/or of common carotid artery (CCA) stenoses. The vascular lesions were diagnosed with Doppler ultrasonography and selective digital angiography. Patients with >70% stenoses of ICA and/or CCA were scheduled for carotid artery stenting (CAS). They were followed-up with neurological examinations and Doppler ultrasonography at 6, 12, and 24 months after stenting. RESULTS: Radiation-induced vascular diseases occurred in the ICA in 22 patients (85%), CCA in 15 (58%), and in ECA in 15 (58%). The stents were implanted in 25 ICA and 17 CCA. Thirteen patients (50%) had one stent, eight (30%) had two stents, four (15%) had three stents, and one patient had five stents. Overall, 46 stents were implanted. Technical success was achieved in all patients. No cerebrovascular events occurred in the 24-months follow-up. CONCLUSION: RT in patients with HNSCC holds a significant risk factor of developing carotid artery stenosis and cerebrovascular events. Carotid stenting is preferable mode of treatment for radiation-induced stenosis. A screening program with doppler ultrasonography enables pre-stroke detection of carotid stenosis.

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Carotid stenosis prevalence after radiotherapy in nasopharyngeal carcinoma: A meta-analysis

Cited by 32 publications

References 32 publications

Contralateral Lower Neck Sparing Radiotherapy in Stage N1 Nasopharyngeal Carcinoma: Long-Term Survival Outcomes and Late Toxicities

Contralateral Lower Neck Sparing Radiotherapy in Stage N1 Nasopharyngeal Carcinoma: Long-Term Survival Outcomes and Late Toxicities

Imaging of nonatheromatous carotid artery disease

Management of Radiation Induced Carotid Stenosis in Head and Neck Cancer

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