Hemodynamic analysis of radiation-induced damage in common carotid arteries by using color Doppler ultrasonography

Mohammadkarim, Alireza; Mokhtari‐Dizaji, Manijhe; Kazemian, Ali; Saberi, Hooshang

doi:10.14366/usg.17016

Cited by 14 publications

(9 citation statements)

References 22 publications

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“…Thus, future survivorship care plans should include stroke as a complication and its management. For example, carotid artery sonography should be performed regularly to detect the carotid artery stenosis , and early interventions such as antiplatelets or stent insertion could be applied, although the benefits are still undetermined .…”

Section: Resultsmentioning

confidence: 99%

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

et al. 2019

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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.

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Section: Resultsmentioning

confidence: 99%

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

et al. 2019

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“…Radiation promoted the aging process in blood vessels and accelerated the risk of ischemic stroke in the OCC survivors after primary surgery. Therefore, secondary prevention should include stroke as a late complication for surveillance in cancer survivorship programs which may incorporate regular follow-up by carotid artery sonography and early interventions such as anti-coagulants or stent insertion [19,20].…”

Section: Discussionmentioning

confidence: 99%

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

Kuan

Lee

Huang

et al. 2020

Cancers

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The number of oral cavity carcinoma (OCC) survivors continues to increase due to advances in definitive surgery and radiation therapy (RT), however the risk of ischemic stroke is unclear in long-term survivors. In this study, survivors are defined as those who survived for >5 years after a diagnosis of OCC. They were matched at a 1:5 ratio with normal controls. Those who received surgery alone versus surgery+RT were also matched at a 1:1 ratio. From 2000 to 2005, 5172 OCC survivors who received surgery alone (n = 3205) or surgery+RT (n = 1967), and 25,860 matched normal controls were analyzed using stratified Cox regression models. Adjusted HRs (aHR) revealed that the surgery+RT group (aHR = 1.68, p < 0.001) had an elevated risk of stroke, but this was not seen in the surgery alone group (aHR = 0.99, p = 0.953). Furthermore, the age at stroke onset was at least 10 years earlier in the surgery+RT group than in the controls. In conclusion, radiotherapy increased the risk of ischemic stroke by 68% and also accelerated the onset of stroke in long-term OCC survivors after primary surgery compared with matched normal controls. Secondary prevention should include stroke as a late complication in OCC survivorship programs.

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“…Mechanisms underlying stroke risk as a result of radiation exposure have been addressed in previous radiobiology studies. An increasing number of studies have indicated that post-irradiation damage to the arteries and heart is one of the most common undesirable effects of radiotherapy in cancer patients ( 22 ). These arterial changes may lead to late adverse effects of radiotherapy such as strokes or ischemic attacks ( 23 ).…”

Section: Discussionmentioning

confidence: 99%

Radiotherapy Exposure in Cancer Patients and Subsequent Risk of Stroke: A Systematic Review and Meta-Analysis

Huang

Zhou

et al. 2019

Front. Neurol.

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Background: Cancer patients who have undergone radiotherapy may have an increased risk of subsequent stroke. A clear and detailed understanding of this risk has not been established.Methods: A search for research articles published from January 1990 to November 2017 in the English language was conducted. Subsequent stroke risk in cancer survivors was compared using relative risk (RR) and 95% confidence intervals (CI) according to whether or not radiotherapy was given.Results: A total of 12 eligible studies were identified including 57,881 total patients. All studies were retrospective, as no prospective studies were identified. The meta-analysis revealed a higher overall risk of subsequent stroke in cancer survivors/patients given radiotherapy compared to those not given radiotherapy (RR: 2.09, 95% CI: 1.45, 3.16). In addition, compared to patients not given radiotherapy, there was an increased risk of subsequent stroke for radiotherapy treated patients with Hodgkin's lymphoma (RR: 2.81, 95% CI: 0.69, 4.93) or head/neck/brain/nasopharyngeal cancer (RR: 2.16, 95% CI: 1.16, 3.16), for patients younger than 40 years (RR: 3.53, 95% CI: 2.51, 4.97) or aged 40–49 years (RR: 1.23, 95% CI: 1.09, 1.45) and for patients treated in Asia (RR: 1.88, 95% CI: 1.48, 2.29), the United States (RR: 1.62, 95% CI: 1.01, 2.23), or in Europe (RR: 4.11, 95% CI 2.62, 6.45).Conclusions: The available literature indicates an approximate overall doubling of the subsequent stroke risk in cancer patients given radiotherapy. The elevated risk was generally statistically significant according to cancer type, baseline patient age and region or country where treatment was given. Caution is required in interpreting these findings due to the heterogeneity of populations represented and lack of standardization and completeness across published studies. Further, if real, we cannot conclude the extent to which patient, treatment and/or investigational factors are responsible for this apparent elevated risk. An objective and more detailed understanding of the risks of radiotherapy, and how to prevent them, is urgently required. It is the responsibility of all who provide cancer services to ensure that the experience of all their patients is documented and analyzed using quality registries.

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Hemodynamic analysis of radiation-induced damage in common carotid arteries by using color Doppler ultrasonography

Cited by 14 publications

References 22 publications

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

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

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

Radiotherapy Exposure in Cancer Patients and Subsequent Risk of Stroke: A Systematic Review and Meta-Analysis

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