Carmody B J, Arora S, Avena R, Curry K M, Simpkins J, Cosby K, Sidawy A N
Department of Surgery, Veterans Affairs Medical Center, Washington, DC 20422, USA.
J Vasc Surg. 1999 Dec;30(6):1045-51. doi: 10.1016/s0741-5214(99)70042-x.
High-dose external radiotherapy used in the treatment of head and neck carcinoma has been implicated as a risk factor for accelerated atherosclerotic disease of the carotid arteries. However, how radiotherapy affects atherosclerotic disease is controversial, and little data exist to demonstrate a strong relationship between radiotherapy and progressive carotid disease.
We performed a retrospective chart review of 69 patients (all men) who underwent duplex ultrasound scanning examinations for carotid disease between 1993 and 1998. Twenty-three patients had received high-dose radiotherapy for the treatment of head and neck carcinoma within the past 12 years (group 1; mean age, 67.8 years), and 46 patients were randomly selected as age-matched control subjects (group 2; mean age, 68.3 years). The mean radiation dose was 6060 +/- 182 rads, and the average interval between radiotherapy and ultrasound scanning was 6. 5 +/- 1.8 years. There was no significant difference between the two groups in the presence of these comorbidities: diabetes mellitus, coronary artery disease, hypertension, tobacco use, hypercholesterolemia, peripheral vascular disease, or stroke. Similarly, there was no difference in the indications for the duplex scanning studies.
Five of the 23 patients in group 1 (21. 7%) were found to have advanced carotid disease (70% to 99% stenosis); four patients were symptomatic, three patients went on to endarterectomy, and one patient was awaiting surgery. Two of the 46 patients in the control group (4%) had advanced carotid disease. One patient was symptomatic, and both patients underwent endarterectomy. A significant difference in the prevalence of advanced disease between the two groups was noted (P =.037). Sixteen patients who survived irradiation underwent a second duplex scanning study and had evidence of progressive disease with significant increases in peak systolic velocities.
High-dose radiotherapy to the head and neck region may be a significant risk factor for accelerated carotid atherosclerotic disease. Routine carotid duplex surveillance may be warranted in this high-risk patient population.
用于治疗头颈癌的高剂量外照射放疗被认为是颈动脉加速动脉粥样硬化疾病的一个危险因素。然而，放疗如何影响动脉粥样硬化疾病存在争议，且几乎没有数据能证明放疗与进行性颈动脉疾病之间存在密切关系。
我们对1993年至1998年间因颈动脉疾病接受双功超声扫描检查的69例患者（均为男性）进行了回顾性病历审查。23例患者在过去12年内接受了高剂量放疗以治疗头颈癌（第1组；平均年龄67.8岁），46例患者被随机选为年龄匹配的对照对象（第2组；平均年龄68.3岁）。平均辐射剂量为6060±182拉德，放疗与超声扫描之间的平均间隔为6.5±1.8年。两组在这些合并症（糖尿病、冠状动脉疾病、高血压、吸烟、高胆固醇血症、外周血管疾病或中风）的存在情况上无显著差异。同样，双功扫描研究的指征也无差异。
第1组的23例患者中有5例（21.7%）被发现患有晚期颈动脉疾病（70%至99%狭窄）；4例患者有症状，3例患者接受了内膜切除术，1例患者等待手术。对照组的46例患者中有2例（4%）患有晚期颈动脉疾病。1例患者有症状，2例患者均接受了内膜切除术。两组晚期疾病患病率存在显著差异（P = 0.037）。16例放疗后存活的患者接受了第二次双功扫描研究，并有疾病进展的证据，收缩期峰值速度显著增加。
对头颈部区域进行高剂量放疗可能是颈动脉加速动脉粥样硬化疾病的一个重要危险因素。在这一高危患者群体中，可能有必要进行常规颈动脉双功监测。
