Cerebrovascular Disease Risk in Older Head and Neck Cancer Patients After Radiotherapy

Abstract

Purpose Cerebrovascular disease is common in head and neck cancer patients, but it is unknown whether radiotherapy increases the cerebrovascular disease risk in this population. Patients and Methods We identified 6,862 patients (age > 65 years) from the Surveillance, Epidemiology, and End Results (SEER) –Medicare cohort diagnosed with nonmetastatic head and neck cancer between 1992 and 2002. Using proportional hazards regression, we compared risk of cerebrovascular events (stroke, carotid revascularization, or stroke death) after treatment with radiotherapy alone, surgery plus radiotherapy, or surgery alone. To further validate whether treatment groups had equivalent baseline risk of vascular disease, we compared the risks of developing a control diagnosis, cardiac events (myocardial infarction, percutaneous coronary intervention, coronary artery bypass graft, or cardiac death). Unlike cerebrovascular risk, no difference in cardiac risk was hypothesized. Results Mean age was 76 ± 7 years. Ten-year incidence of cerebrovascular events was 34% in patients treated with radiotherapy alone compared with 25% in patients treated with surgery plus radiotherapy and 26% in patients treated with surgery alone (P < .001). After adjusting for covariates, patients treated with radiotherapy alone had increased cerebrovascular risk compared with surgery plus radiotherapy (hazard ratio [HR] = 1.42; 95% CI, 1.14 to 1.77) and surgery alone (HR = 1.50; 95% CI, 1.18 to 1.90). However, no difference was found for surgery plus radiotherapy versus surgery alone (P = .60). As expected, patients treated with radiotherapy alone had no increased cardiac risk compared with the other treatment groups (P = .63 and P = .81). Conclusion Definitive radiotherapy for head and neck cancer, but not postoperative radiotherapy, was associated with excess cerebrovascular disease risk in older patients.

Long-term Cardiovascular Toxicity in Children, Adolescents, and Young Adults Who Receive Cancer Therapy: Pathophysiology, Course, Monitoring, Management, Prevention, and Research Directions

“…618,619 Exercise capacity is a topic of active discussion among pediatricians. 620 Cardiac dysfunction in long-term survivors exposed to anthracyclines is associated with abnormal cardiac structure and function that can cause restrictive cardiomyopathy 163 ( Figure 1) and that may be one factor that decreases exercise capacity. However, exercise capacity is sometimes poorly correlated with cardiac function, because several other late factors can influence exercise capacity.…”

“…162 Preexisting atherosclerosis at time of treatment may be an exacerbating factor. 158,163 Consequently, risk factors include hypertension, obesity, smoking, diabetes mellitus, and other known associations with both cardiac and cerebrovascular disease in the general population.…”

Human Papillomavirus Status and the Risk of Cerebrovascular Events Following Radiation Therapy for Head and Neck Cancer

“…This was specifically defined as a composite of ischemic stroke and TIA. We chose this outcome based on data showing an increase in the combination of stroke and TIA after neck RT 3, 4, 18. Death was also reported but was not the focus of this study 19.…”

2016 European Guidelines on cardiovascular disease prevention in clinical practice

“…Kardiotoksyczność wynikająca z radioterapii w obrębie klatki piersiowej może powodować uszkodzenia mniejszych i większych naczyń krwionośnych. Może ona przyspieszać rozwój miażdżycy, lecz może to wystąpić wiele lat po początkowym narażeniu [163][164][165][166][167][168][169]. Utajenie i stopień nasilenia kardiotoksyczności wynikającej z radioterapii jest związany z wieloma czynnikami, obejmującymi dawkę (frakcyjną), objętość serca, która uległa napromieniowaniu, jednoczesne podawanie innych leków kardiotoksycznych i czynników związanych z pacjentem (młodszy wiek, tradycyjne czynniki ryzyka [170], choroba serca w wywiadzie).…”