Risk of fatal cerebrovascular accidents after external beam radiation therapy for early-stage glottic laryngeal cancer

Abstract

Background This study compared the risk of fatal cerebrovascular accidents (CVA) in patients with early stage glottic larynx cancer receiving surgery or external beam radiation therapy (EBRT). Methods and Materials Using a competing risks survival analysis, we compared the risk of death due to CVA among patients with early stage glottic larynx cancer receiving surgery or EBRT in the SEER database. Results The cumulative incidence of fatal CVA at 15 years was higher in patients receiving EBRT (2.8 %; 95% CI 2.3%–3.4%) compared to surgery (1.5 %; 95% CI 0.8 %–2.3%, p= 0.024). In multivariable competing risks regression models, EBRT remained associated with an increased risk of fatal CVA compared to surgery (adjusted HR 1.75; 95% CI 1.04–2.96, p= 0.037). Conclusion Treatment of early stage glottic larynx cancer with EBRT was associated with a small increase in the risk of late fatal CVA events relative to surgery.

Hypofractionated radiotherapy for early glottic cancer: a retrospective interim analysis of a single institution

“…RT may increase the risk of cerebrovascular accidents (CVA) [13]. Although there was no patient in the present study who had CVA after RT, a higher risk of fatal CVA after RT was reported in patients receiving RT than the risk associated with surgery for EGC in the Surveillance, Epidemiology, and End Results (SEER) database (2.8% vs. 1.5%, p = 0.037) [28]. Other SEER analyses revealed an increased incidence of CVA in elderly EGC patients at approximately 8% in patients receiving RT than surgery [29,30].…”

Hypofractionated radiotherapy for early glottic cancer: a retrospective interim analysis of a single institution

“…RT may increase the risk of cerebrovascular accidents (CVA) [13]. Although there was no patient in the present study who had CVA after RT, a higher risk of fatal CVA after RT was reported in patients receiving RT than the risk associated with surgery for EGC in the Surveillance, Epidemiology, and End Results (SEER) database (2.8% vs. 1.5%, p = 0.037) [28]. Other SEER analyses revealed an increased incidence of CVA in elderly EGC patients at approximately 8% in patients receiving RT than surgery [29,30].…”

Outcome of Early-Stage Glottic Laryngeal Carcinoma Patients Treated with Radical Radiotherapy Using Different Techniques

“…Functional preservation of the larynx in the treatment of early-stage glottic laryngeal carcinomas is important to improve local control and survival. However, as with patients with laryngeal carcinoma in our series, the quality of life deteriorates frequently due to secondary malignancy or nonmalignant reasons and patients lose their lives [13, 16, 23]. Especially in patients above 65, there is no difference between surgery and RT, in terms of deaths caused by cardiac and cerebrovascular system diseases [14].…”

Risk of CVD Following Radiotherapy for Head and Neck Cancer: An Updated Systematic Review and Meta-Analysis

“…Twenty-two studies were included ( 4 – 7 , 14 – 31 ). Within the 22 studies, there were six cohort studies, of which two studies reported RR ( 6 , 14 ), and another four studies reported HR ( 4 , 5 , 15 , 16 ). Moreover, there were 13 studies with case–control study designs ( 7 , 17 – 28 ), and another three studies ( 29 – 31 ) reported the number of patients with carotid stenosis after neck radiation.…”

Hypofractionated radiotherapy for early glottic cancer: a retrospective interim analysis of a single institution

“…RT may increase the risk of cerebrovascular accidents (CVA) [13]. Although there was no patient in the present study who had CVA after RT, a higher risk of fatal CVA after RT was reported in patients receiving RT than the risk associated with surgery for EGC in the Surveillance, Epidemiology, and End Results (SEER) database (2.8% vs. 1.5%, p = 0.037) [28]. Other SEER analyses revealed an increased incidence of CVA in elderly EGC patients at approximately 8% in patients receiving RT than surgery [29,30].…”

Outcome of Early-Stage Glottic Laryngeal Carcinoma Patients Treated with Radical Radiotherapy Using Different Techniques

“…Functional preservation of the larynx in the treatment of early-stage glottic laryngeal carcinomas is important to improve local control and survival. However, as with patients with laryngeal carcinoma in our series, the quality of life deteriorates frequently due to secondary malignancy or nonmalignant reasons and patients lose their lives [13, 16, 23]. Especially in patients above 65, there is no difference between surgery and RT, in terms of deaths caused by cardiac and cerebrovascular system diseases [14].…”

Risk of CVD Following Radiotherapy for Head and Neck Cancer: An Updated Systematic Review and Meta-Analysis

“…Twenty-two studies were included ( 4 – 7 , 14 – 31 ). Within the 22 studies, there were six cohort studies, of which two studies reported RR ( 6 , 14 ), and another four studies reported HR ( 4 , 5 , 15 , 16 ). Moreover, there were 13 studies with case–control study designs ( 7 , 17 – 28 ), and another three studies ( 29 – 31 ) reported the number of patients with carotid stenosis after neck radiation.…”

Hypofractionated radiotherapy for early glottic cancer: a retrospective interim analysis of a single institution

“…RT may increase the risk of cerebrovascular accidents (CVA) [13]. Although there was no patient in the present study who had CVA after RT, a higher risk of fatal CVA after RT was reported in patients receiving RT than the risk associated with surgery for EGC in the Surveillance, Epidemiology, and End Results (SEER) database (2.8% vs. 1.5%, p = 0.037) [28]. Other SEER analyses revealed an increased incidence of CVA in elderly EGC patients at approximately 8% in patients receiving RT than surgery [29,30].…”

Outcome of Early-Stage Glottic Laryngeal Carcinoma Patients Treated with Radical Radiotherapy Using Different Techniques

“…Functional preservation of the larynx in the treatment of early-stage glottic laryngeal carcinomas is important to improve local control and survival. However, as with patients with laryngeal carcinoma in our series, the quality of life deteriorates frequently due to secondary malignancy or nonmalignant reasons and patients lose their lives [13, 16, 23]. Especially in patients above 65, there is no difference between surgery and RT, in terms of deaths caused by cardiac and cerebrovascular system diseases [14].…”

Risk of CVD Following Radiotherapy for Head and Neck Cancer: An Updated Systematic Review and Meta-Analysis

“…Twenty-two studies were included ( 4 – 7 , 14 – 31 ). Within the 22 studies, there were six cohort studies, of which two studies reported RR ( 6 , 14 ), and another four studies reported HR ( 4 , 5 , 15 , 16 ). Moreover, there were 13 studies with case–control study designs ( 7 , 17 – 28 ), and another three studies ( 29 – 31 ) reported the number of patients with carotid stenosis after neck radiation.…”