Changes in the Common Carotid Artery after Radiotherapy: Wall Thickness, Calcification, and Atherosclerosis

Abstract

Background and PurposeSince the long-term survival rate has improved in laryngeal cancer patients who receive radiotherapy, concerns about postradiation complications (including carotid atherosclerosis) have increased. We followed changes in the common carotid artery (CCA) after radiotherapy and identified the underlying risk factors.MethodsConsecutive patients with laryngeal cancer who underwent radiotherapy between January 1999 and December 2009 and who had received computed tomography (CT) both pre- and postradiotherapy were enrolled. Changes in the wall thickness and in the vessel and lumen areas as well as the presence of calcification or atherosclerosis were investigated. Demographics and risk factors were compared between patients with and without atherosclerosis at follow-up CT.ResultsIn total, 125 patients were enrolled. The wall thickness had increased and the lumen area had decreased several months after radiotherapy. These changes were not associated with vascular risk factors and were not progressive. Calcification and atherosclerosis were observed in 37 (29.6%) and 71 (56.8%) patients, respectively. Diabetes was associated with calcification (p=0.02). The prevalence of hyperlipidemia was higher in patients with atherosclerosis (28.2% vs. 11.1%, p=0.02) and for a longer period postradiation [62.7±32.1 vs. 40.0±24.2 months (mean±SD), p<0.001]. Atherosclerosis occurred mostly in the middle portion of the CCA (n=31, 24.6%), followed by the proximal CCA at the intrathoracic level (n=26, 20.6%) and the distal CCA (n=6, 4.8%). Positive remodeling was also observed, but this was less common in patients with calcification (p=0.02).ConclusionsVarious types of postradiation changes occur in the CCA and can be easily observed in postradiation CT. The prevalence and burden of postradiation atherosclerosis increased in a close relationship with baseline cholesterol levels and the time after radiotherapy. Postradiation atherosclerosis was observed at unusual sites of the CCA.

Longitudinal atherosclerotic changes after radio(chemo)therapy of hypopharyngeal carcinoma

“…Few longitudinal studies include measurements before RT and those have a maximal follow-up of 2 years [8,12]. While a continuous progression was observed in one study [12], no change could be observed in another one [8]. The present analysis with a maximal follow-up of 4.5 years supports an initial increase in intima media thickness, though no major development could be observed after about one year (Fig.…”

“…Most of these results, however, are based on cross-sectional studies. Few longitudinal studies include measurements before RT and those have a maximal follow-up of 2 years [8,12]. While a continuous progression was observed in one study [12], no change could be observed in another one [8].…”

“…Radiation vasculopathy can manifest itself in an increase in plaques, thickening of the intima media, and stenosis. These impairments have been primarily observed in ultrasound examinations [3][4][5] but can also be seen in CT [6][7][8], and MRI follow-ups [9,10].…”

“…Carotid stenosis is an established side-effect after local cancer radiotherapy [11]. Only few studies, however, have monitored the atherosclerotic development longitudinally from the onset of RT and including several time points [8,12]. Therefore, the exact dynamics of the arterial deterioration remains unknown.…”

Management of Radiation Induced Carotid Stenosis in Head and Neck Cancer

“…They were found in all segments of the carotid arteries, primarily in the CCA and proximal segments of the ICA and ECA. A remarkable variation of radiological symptoms and the multifocal appearance of radiation-induced vascular diseases have been also reported in the literature [11], [18], [19].…”