Long-term effects on carotid intima-media thickness after radiotherapy in patients with nasopharyngeal carcinoma

Huang, Tai Lin; Hsu, Hsuan Chih; Chen, Hui Chun; Lin, Huang‐Chi; Chien, Chih‐Yen; Fang, Fu Min; Huang, Chih Cheng; Chang, Hung‐Wen; Chang, Wen‐Cheng; Huang, Chao‐Cheng; Tsai, Nai‐Wen; Kung, Chia Te; Wang, Hung-Chen; Lin, Wei Che; Cheng, Bi-Hua; Su, Yu‐Jih; Chang, Ya Ting; Chang, Chuang Rung; Tan, Teng Yeow; Lu, Cheng Hsien

doi:10.1186/1748-717x-8-261

Cited by 42 publications

(38 citation statements)

References 16 publications

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“…In contrast, if patients do not have carotid plaque, the screening for carotid plaque may be performed in the fourth year after RT. This is because, firstly, it has been shown that carotid plaque is less likely to be found in the first two years after RT [4]; secondly, in the present study, carotid plaque was found in 60 % of patients with a post-RT duration of 4 years (3 out of 5 patients), which was consistent with the finding of a previous study in which 42.5 months was suggested as the cut-off value for post-RT duration for the presence of carotid plaque (around 3.5 years, a sensitivity of 68.4 % and a specificity of 50 %) [33]. When carotid plaque is found, the degree of carotid stenosis and the stability of carotid plaque can be assessed, and appropriate and prompt medications can be given to these patients to alleviate the progression of carotid atherosclerosis, which may reduce the risk of stroke.…”

Section: Discussionsupporting

confidence: 93%

Ultrasound Evaluation of Carotid Atherosclerosis in Post-Radiotherapy Nasopharyngeal Carcinoma Patients, Type 2 Diabetics, and Healthy Controls

Yuan

Yip

et al. 2015

Ultraschall in Med

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To comprehensively evaluate and compare the degree of carotid atherosclerosis in patients treated with radiotherapy (RT) for nasopharyngeal carcinoma (NPC) and in patients with type 2 diabetes mellitus (DM), and using healthy subjects as controls. The present study recruited 69 post-RT NPC patients without conventional cardiovascular risk factors, 70 type 2 diabetic patients without previous RT, and 76 healthy controls without conventional cardiovascular risk factors and previous RT. For each participant, 5 carotid atherosclerotic parameters, namely carotid intima-media thickness (CIMT), carotid arterial stiffness (CAS), presence of carotid plaque, carotid plaque score, and presence of ≥ 50 % carotid stenosis, were assessed using ultrasonography. The differences in these carotid atherosclerotic parameters between study groups were compared using ANCOVA or logistic regression after the adjustment for age and gender. Multiple comparisons were corrected using the Benjamini-Hochberg false discovery rate. Post-RT NPC patients and type 2 diabetics had a significantly higher CIMT, CAS and carotid plaque burden compared to the healthy subjects (corrected P-value, Pcor < 0.05). In addition, carotid atherosclerosis in post-RT NPC patients tended to be more severe with significantly higher CAS and carotid plaque burden than that in type 2 diabetics (Pcor < 0.05). Neck RT for NPC is an independent risk factor of carotid atherosclerosis, and radiation induces more severe carotid atherosclerosis in post-RT NPC patients. Thus, assessment of carotid atherosclerosis using ultrasonography may be necessary for these patients and should be indicated in the routine follow-up of NPC.

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Section: Discussionsupporting

confidence: 93%

Ultrasound Evaluation of Carotid Atherosclerosis in Post-Radiotherapy Nasopharyngeal Carcinoma Patients, Type 2 Diabetics, and Healthy Controls

Yuan

Yip

et al. 2015

Ultraschall in Med

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“…Although different predictors of carotid intima-media thickness (CIMT) and carotid stenosis in patients treated with neck RT have been reported in previous studies [7] , [8] , no previous studies have investigated the cumulative effect of conventional cardiovascular risk factors, such as diabetes mellitus, hypertension, hyperlipidemia and smoking, on radiation-induced carotid atherosclerosis in post-RT NPC patients. In addition, significant carotid stenosis (≥50% stenosis) is an important indicator of carotid atherosclerosis and is useful for predicting cerebrovascular events [9] , [10] .…”

Section: Introductionmentioning

confidence: 99%

Predictors of the Extent of Carotid Atherosclerosis in Patients Treated with Radiotherapy for Nasopharyngeal Carcinoma

Yuan

Wu²,

Yip³

et al. 2014

PLoS ONE

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ObjectiveTo determine the predictors of the extent of carotid atherosclerosis in patients treated with radiotherapy (RT) for nasopharyngeal carcinoma (NPC).MethodsThe present study investigated 129 post-RT NPC patients. Carotid atherosclerotic parameters, such as carotid intima-media thickness, carotid arterial stiffness and carotid plaque burden (plaque score, the presence of plaque and ≥50% stenosis) were assessed using ultrasonography. The association between carotid atherosclerotic parameters and nine potential predictors, including age, gender, post-RT duration, radiation dose, chemotherapy, diabetes mellitus, hypertension, hypercholesterolemia, and smoking, were determined using multiple regression. The cutoff values of age, post-RT duration and number of cardiovascular risk factors for the presence of carotid plaque or ≥50% carotid stenosis were analyzed using receiver operating characteristic (ROC) curve analysis. Multiple testing was corrected using Benjamini-Hochberg false discovery rate.ResultsAge, post-RT duration and number of cardiovascular risk factors were significantly associated with carotid plaque burden (corrected P value, Pcor<0.05). Age of 44.5 years (sensitivity = 99.2% and specificity = 50%, Pcor<0.01) and post-RT duration of 8.5 years (sensitivity = 75.7% and specificity = 64.3%, Pcor<0.001) were the cutoff values for detecting carotid plaque, while post-RT duration of 13.5 years (sensitivity = 66.7% and specificity = 71.6%, Pcor<0.001) and 1.5 cardiovascular risk factors (sensitivity = 40.7% and specificity = 84.3%, Pcor<0.05) were the cutoff values for screening ≥50% carotid stenosis.ConclusionsAge, post-RT duration and number of cardiovascular risk factors are significant predictors of carotid atherosclerosis in post-RT NPC patients. Post-RT NPC patients, who are at least 45 years old, with post-RT duration of 9 years or above, and/or have ≥2 cardiovascular risk factors, are more susceptible to carotid atherosclerosis.

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“…Nevertheless, there were only 8 patients (8/96, 8%) with moderate ICA stenosis (30-69%) and none with common carotid artery (CCA) or ICA stenosis of ≥70% or occlusion. Similarly, Huang et al [4] showed that the intima-media thickness (IMT) of the CCA was significantly increased in nasopharyngeal carcinoma patients after RT compared to the control group. They also found that the IMT, a good indicator of the severity of atherosclerotic disease, increased in a linear manner with duration of RT.…”

Section: Incidence and Prevalence Of Rt-induced Carotid Stenosismentioning

confidence: 99%

“…In addition, the IMT increased linearly with duration of RT [4]. Furthermore, elderly patients with increased CIMT and without a history of cardiovascular disease are directly associated with a remarkably higher risk of myocardial infarction and stroke [33] .…”

Section: Diagnosismentioning

confidence: 99%

Radiation-Induced Carotid Artery Stenosis: A Comprehensive Review of the Literature

Cao

2013

Intervent Neurol

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In recent decades, with the improvement of radiotherapy (RT) technology and comprehensive treatment, the survival rate of head and neck malignancies has gained remarkable progress. Vascular injury and subsequent carotid stenosis following RT, as the backbone of treatment, have received increasing attention. Many investigations have demonstrated that radiation can result in the increase in carotid intima-media thickness, carotid stenosis and consequently lead to a higher risk of cerebrovascular events such as transient ischemic attack and stroke. In this review, we will examine the incidence of radiation-induced carotid artery stenosis, its morphological and histological characteristics, as well as its pathogenesis. The treatment and prevention methods, including follow-up strategies, will also be discussed at the end of the present review.

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Long-term effects on carotid intima-media thickness after radiotherapy in patients with nasopharyngeal carcinoma

Cited by 42 publications

References 16 publications

Ultrasound Evaluation of Carotid Atherosclerosis in Post-Radiotherapy Nasopharyngeal Carcinoma Patients, Type 2 Diabetics, and Healthy Controls

Ultrasound Evaluation of Carotid Atherosclerosis in Post-Radiotherapy Nasopharyngeal Carcinoma Patients, Type 2 Diabetics, and Healthy Controls

Predictors of the Extent of Carotid Atherosclerosis in Patients Treated with Radiotherapy for Nasopharyngeal Carcinoma

Radiation-Induced Carotid Artery Stenosis: A Comprehensive Review of the Literature

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