Carotid artery stenosis and ischemic cerebrovascular events after radiotherapy in patients with head and neck cancer
Nawaphan Taengsakul, Padungcharn Nivatpumin, Thong Chotchutipan, Sunanta Tungfung
Abstract
Radiotherapy is the main treatment for patients with head and neck cancer (HNC) and is associated with an increased risk of ischemic cerebrovascular events (ICVE). The purpose of this cross-sectional study was to determine the incidence of ICVE and carotid artery stenosis (CAS) in patients with HNC who receive radiotherapy and the risk factors for CAS.
Introduction
Radiotherapy is recommended in approximately 80% of patients with head and neck cancer (HNC) and may be combined with surgery or systemic treatment [1,2]. Survival rates are gradually improving as a result of more intensive regimens, and there is an increasing emphasis on preventing the long-term adverse events of radiotherapy in these patients [3].
Materials and methods
The study had a retrospective cohort design and included 907 patients with HNC involving the oral cavity, pharynx, larynx, nasal cavity, or salivary glands. The missing data from incomplete follow-up was 44 cases (4.8%) due to a desire to follow up at their nearby hospital that was missing.
Results
The patient and tumor characteristics are shown in Table 1. Approximately three-quarters of the patients were male and under the age of 65 years. More than half of the patients were of normal weight, with one-quarter being underweight.
Discussion
In this study, we found that the incidence of ICVE after radiotherapy for HNC was only 1.98% during a mean follow-up of 3.34 ± 3.14 years, with only one case (0.11%) of symptomatic CAS after treatment. A previous literature review found that radiotherapy to the head and neck area increased the risk of neurological events by at least two-fold [5].
Conclusions
This study found that the incidence of ICVE and the cumulative incidence of CAS were lower in the Thai population with HNC than in other populations.
Citation: Taengsakul N, Nivatpumin P, Chotchutipan T, Tungfung S (2025) Carotid artery stenosis and ischemic cerebrovascular events after radiotherapy in patients with head and neck cancer. PLoS ONE 20(1): e0314861. https://doi.org/10.1371/journal.pone.0314861
Editor: Paula Boaventura, IPATIMUP/i3S, PORTUGAL
Received: August 27, 2024; Accepted: November 18, 2024; Published: January 30, 2025
Copyright: © 2025 Taengsakul et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Data Availability: All relevant data are within the manuscript and its Supporting Information files.
Funding: The author(s) received no specific funding for this work.
Competing interests: The authors have declared that no competing interests exist.
