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. 2024 Aug 27;16(17):2982.
doi: 10.3390/cancers16172982.

Radiation Dose-Induced Carotid Artery Stenosis and Brain Necrosis in Head and Neck Cancer-A Real World Cohort Study

Henry W C Leung  1 , Shyh-Yau Wang  1 , Cheng-Li Lin  2 , Agnes L F Chan  3
Affiliations

Radiation Dose-Induced Carotid Artery Stenosis and Brain Necrosis in Head and Neck Cancer-A Real World Cohort Study

Henry W C Leung et al. Cancers (Basel). .

Abstract

Objective: This study aims to examine whether radiation therapy doses are related to incidences of carotid artery stenosis and brain necrosis in a large-scale real-world database. Methods: We identified a cohort of HNC patients from the catastrophic illness patient dataset using ICD-9 or ICD-10 to compare the incidence and risks of carotid artery stenosis (CAS) and brain necrosis (RIBN) in patients who received a radiation therapy dose of ≥5400 cGy/30 fractions (group A) with those who received a radiation therapy dose of <5400 cGy/30 fractions (group B). The incidence and hazard ratios were quantified using Cox proportional hazards models. Results: A total of 19,964 patients were identified in group A and group B. Among them, 965 and 863 cases of CAS and 435 and 359 cases of RIBN were identified in group A and group B, respectively. There was no statistically significant association between the two groups for CAS risk, whereas there was a statistically significant association between the two groups for RIBN risk. The most common primary site of head and neck cancers was the nasopharynx (1144 of 19,964, 5.73%). Conclusions: Our study suggests that RT may increase the risk of carotid stenosis and brain necrosis in patients with NPC. To ensure patient safety during treatment, the optimal balance between tumor control and toxicity prevention in individual patients through minimization of the radiation dose to all relevant OARs must be properly understood.

Keywords: brain necrosis; carotid artery stenosis; head and neck cancer; nasopharyngeal cancer; radiation therapy.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Flow chart of participants selection and study design. RIBN, radiotherapy induced brain necrosis Dose ≥ 30 times (≥5400 cGy/30 fraction).
Figure 2
Figure 2
Cumulative incidence of carotid artery stenosis and brain necrosis among head and neck patients with radiation doses cGy5400 ≥ 30 fractions vs. < cGy5400/30 fractions. Incidence rate of (A) carotid artery stenosis; (B) radiation-induced brain necrosis; (C) overall mortality rate.
Figure 3
Figure 3
Sensitivity analysis. (A) Adjusted hazard ratio of brain necrosis. (B) Adjusted hazard ratio of carotid artery stenosis. Remarks: * Adjusted for sex, age, comorbidities, CCI category and primary site of head and neck cancer, tumor grade. ** Adjusted for sex, age, CCI category, comorbidities, primary site of Head and neck cancer, tumor grade. HRadj: adjusted hazard ratio.
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References

    1. Global Cancer Observatory; International Agency for Research on Cancer; World Health Organization. [(accessed on 20 December 2023)]. Available online: https://gco.iarc.fr/today/home.
    1. Taiwan Cancer Registry Center. 2020. [(accessed on 23 June 2023)]. Available online: https://twcr.tw/?page_id=1855&lang=en.
    1. Vigneswaran N., Williams M.D. Epidemiologic trends in head and neck cancer and aids in diagnosis. Oral. Maxillofac Surg. Clin. N. Am. 2014;26:123–141. doi: 10.1016/j.coms.2014.01.001. - DOI - PMC - PubMed
    1. Chi A.C., Day T.A., Neville B.W. Oral cavity and oropharyngeal squamous cell carcinoma—An update. CA Cancer J. Clin. 2015;65:401–421. doi: 10.3322/caac.21293. - DOI - PubMed
    1. Alfouzan A.F. Radiation therapy in head and neck cancer. Saudi Med. J. 2021;42:247–254. doi: 10.15537/smj.2021.42.3.20210660. - DOI - PMC - PubMed

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