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Do traditional risk stratification models for cerebrovascular events apply in irradiated head and neck cancer patients?

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Date
2016-06
ICR Author
Nutting, Chris
Harrington, Kevin
Author
Gujral, DM
Shah, BN
Chahal, NS
Bhattacharyya, S
Senior, R
Harrington, KJ
Nutting, CM
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Type
Journal Article
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Abstract
Background Primary radical radiotherapy (RT) for head and neck cancer (HNC) often results in significant radiation dose to the carotid arteries.Aim We assessed whether HNC patients are at increased risk of a cerebrovascular event primarily due to RT or other risk factors for atherosclerosis by (i) risk-stratifying patients according to validated QRISK-2 and QSTROKE scores and (ii) comparing the prevalence of carotid artery stenosis (CAS) in irradiated and unirradiated carotid arteries.Design HNC patients treated with an RT dose >50 Gy to one side of the neck ≥2 years previously were included.Methods QRISK-2 (2014) and Q-STROKE (2014) scores were calculated. We compared the prevalence of CAS in segments of the common carotid artery on the irradiated and unirradiated sides of the neck.Results Fifty patients (median age of 58 years (interquartile range (IQR) 50-62)) were included. The median QRISK-2 score was 10% (IQR 4.4-15%) and the median QSTROKE score was 3.4% (IQR 1.4-5.3%). For both scores, no patient was classified as high risk. Thirty-eight patients (76%) had CAS in one or both arteries. There was a significant difference in the number of irradiated arteries with stenosis (N = 37) compared with unirradiated arteries (N = 16) (P < 0.0001). There were more plaques on the irradiated artery compared with the unirradiated side - 64/87 (73.6%) versus 23/87 (26.4%), respectively (P < 0.001). Conclusions Traditional vascular risk factors do not play a role in radiation-induced carotid atherosclerosis. Clinicians should be aware that traditional risk prediction models may under-estimate stroke risk in these patients.
URI
https://repository.icr.ac.uk/handle/internal/578
DOI
https://doi.org/10.1093/qjmed/hcv120
Collections
  • Cancer Biology
  • Radiotherapy and Imaging
Subject
Carotid Arteries
Humans
Head and Neck Neoplasms
Carotid Artery Diseases
Radiation Injuries
Ultrasonography
Radiotherapy Dosage
Prevalence
Logistic Models
Risk Assessment
Risk Factors
Predictive Value of Tests
Middle Aged
Female
Male
Stroke
Research team
Targeted Therapy
Language
eng
License start date
2016-06
Citation
QJM : monthly journal of the Association of Physicians, 2016, 109 (6), pp. 383 - 389

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