High Incidence of Ischemic Stroke Occurrence in Irradiated Lung Cancer Patients: A Population-Based Surgical Cohort Study

Abstract

Background and PurposeA high risk of stroke occurrence has been reported in several types of irradiated cancer patients. However, clinical data are lacking in irradiated lung cancer patients. The present study intended to explore a risk level of ischemic stroke occurrence in irradiated lung cancer patients.MethodsA nationwide population-based database obtained from the Taiwan National Health Insurance was analyzed. Between 2003 and 2006, we recruited 560 resected lung cancer patients into two study groups: surgery-plus-irradiation (n = 112) and surgery-alone (n = 448). Patients treated with chemotherapy were excluded. Propensity score match was used for pairing cases with a ratio of 1∶4. Two-year ischemic-stroke-free survival was defined as the primary endpoint.ResultsThree observations supported a high risk of ischemic stroke occurrence in patients with postoperative irradiation when compared with those patients with surgery alone: first, a high incidence per 1,000 person-year (22.3 versus 11.2, 1.99 folds); second, a low two-year ischemic-stroke-free survival rate (92.2% versus 98.1%, P = 0.019); and third, a high adjusted hazard ratio (HR, 4.19; 95% CI, 1.44–12.22; P = 0.009). More notably, the highest risk of ischemic stroke occurrence was found in irradiated patients who had diabetes mellitus (HR, 34.74; 95% CI, 6.35->100; P<0.0001).ConclusionsA high incidence of ischemic stroke was observed in irradiated lung cancer patients, especially in those with diabetes mellitus. For these patients, close clinical surveillance and strict diabetes control should be considered. Further studies to define detail biological mechanisms are encouraged.

Association between radioiodine treatment for thyroid cancer and risk of stroke

“…Severe morbidities and mortality may follow a stroke. Studies have demonstrated a high risk of stroke in patients receiving radiotherapy treatment for several types of cancer, including breast cancers, head and neck cancers, Hodgkin lymphoma, and lung cancer . Ionizing radiation when exposed to arteries has been reported to cause or accelerate the development of atherosclerosis .…”

Risk of comorbid cardiovascular disease in Korean long‐term cancer survivors

“…Third, the coexistence of cancer and cardiovascular risk factors may intensify their effect on the risk of CVD. In accordance with this hypothesis, a study has reported that the risk of ischaemic stroke is much higher in irradiated lung cancer patients with diabetes (hazard ratio: 34.7; 95% CI: 6.4–100) than that in non‐diabetic but irradiated patients (3.95; 1.97–1.72) and in diabetic but non‐irradiated patients (6.57; 2.21–19.54; Hung et al, ). The risk of comorbid CVD in breast and thyroid cancer survivors with diabetes was higher than that in those without diabetes in subgroup analysis of the present study.…”

“…With regard to the mechanism underlying increased risk of CVD in lung cancer survivors, cardiac toxicity caused by various chemotherapeutic agents or radiotherapy including heart in the irradiation field has been considered (Hung et al, ; Wilbur, ). Interestingly, we found that the increased risk of CVD was confined to those with hypertension.…”

Implementing web-based ping-pong-type e-communication to enhance staff satisfaction, multidisciplinary cooperation, and clinical effectiveness

“…Data were analyzed and reported according to the reporting guideline, that is, SQUIRE (version 2.0). [ 22 , 23 ] SPSS (version 12, IBM SPSS Inc, US) [ 34 ] was used for data analysis. For evaluating intergroup differences of continuous variables, t -test was used.…”

“…For evaluating intergroup differences of continuous variables, t -test was used. Two intramural independent biostatisticians analyzed and validated reported data, as reported previously [ 34 ] ,namely, Miss Hsu (primary analysis) and Miss Tsai (second check). A P value of <0.05 was defined with a statistical significance.…”