Screening for irradiation vasculopathy by intima-media thickness sonography in head and neck cancer patients

Abstract

Purpose Post-irradiation vasculopathy is a severe form of atherosclerosis and affects the prognosis of head and neck cancer survivors. Sonographic intima-media thickness (IMT) precedes stenosis, plaque formation, and cerebrovascular events. Therefore, IMT may be a valuable screening marker for post-irradiation toxicity. However, the critical irradiation dose and the onset of IMT increase remain unclear. Methods The cross-sectional study analysed the carotid artery IMT in 96 irradiated patients and 41 controls regarding irradiation dose, post-irradiation-interval, and cardiovascular risk factors. Distinct irradiation doses to the tumour side and the contralateral hemineck enabled detection of dose depended effects within one patient and control of risk factors. Results Radiotherapy caused a dose-dependent increase in IMT. The toxicity did not have saturation effects for > 60 Gy. The IMT increase occurred in short-term following radiotherapy and the risk for a pathological value (> 0.9 mm) rose significantly. The correlation between IMT and radiotherapy was comparable to established cardiovascular risk factors. Conclusion Radiotherapists should consider the additional toxicity of high doses for non-metastatic head and neck cancer. If neck metastases require radiotherapy with boost, IMT measurement is suitable for early detection of carotid artery damage.

Assessing radiation-induced carotid vasculopathy using ultrasound after unilateral irradiation: a cross-sectional study

“…Longitudinal studies showed higher IMTs in irradiated than in non-irradiated HNC survivors or healthy controls [ 3 , 5 ]. Also, as currently found, higher IMTs in irradiated than non-irradiated carotids in unilateral irradiated patients have been described [ 5 , 14 , 15 ]. Because the latter setting eliminates confounding effects of CVRFs, these results point to a specific cause-effect relation between radiation and carotid wall thickening.…”

“…So far, radiation dose has been associated with IMT [ 14 ], but not with carotid stiffness [ 12 ]. Relatively low radiation doses applied in this study could result in the lack of a dose–effect relation with IMT.…”

Ultrasound Evaluation of Carotid Artery Intima-Media Thickness: Effective Early Marker of Carotid Artery Disease in Adult Head and Neck Cancer Patients After Neck Radiation?

“…Of those treated with radiation, 41 patients received bilateral neck radiation (M = 62.5 Gy ± 7.9), while 55 patients received tumor side boost (M = 61.1 Gy ± 9.7) with contralateral side receiving a lower dose (M = 49.3 Gy ± 15.6). Strüder and colleagues (2020) reported ultrasound measured a 13% mean carotid IMT increase in HNC patients after neck radiation vs. receiving neck dissection alone, and a 20% increase over healthy controls (radiation: n = 96, 0.77 mm ± 0.18; surgery: n = 21, 0.69 mm ± 0.10; control: n = 20, 0.64 mm ± 0.12; p < 0.05). This increase in carotid IMT was maintained over 10 years of follow-up.…”

“…A total of eight articles were reviewed, including four prospective studies ( Faruolo et al, 2013 ; Pereira Lima et al, 2011 ; Toprak et al, 2012 ; Wilbers et al, 2014 ) and four retrospective studies ( Gujral et al, 2016 ; Strüder et al, 2020 ; Yeh et al, 2019 ; Yuan et al, 2017 ; Table 1 ). Although these studies varied in design and included differing secondary endpoints, all reported post-radiation carotid IMT values and compared them to an external control population, an internal contralateral control, or internal control with measurements over time.…”

“… Strüder and colleagues (2020) designed a cross-sectional study analyzing ultrasound measured carotid IMT in 96 irradiated HNC patients (M = 3.1 ± 3.1 years post radiation), 21 HNC patients receiving neck dissection alone, and 20 nonirradiated controls that included both HNC patients receiving surgery only and routine otorhinolaryngology patients. Of those treated with radiation, 41 patients received bilateral neck radiation (M = 62.5 Gy ± 7.9), while 55 patients received tumor side boost (M = 61.1 Gy ± 9.7) with contralateral side receiving a lower dose (M = 49.3 Gy ± 15.6).…”