Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin 53792, USA.
Int J Radiat Oncol Biol Phys. 2013 Oct 1;87(2):290-6. doi: 10.1016/j.ijrobp.2013.06.009. Epub 2013 Jul 29.
Comprehensive neck radiation therapy (RT) has been shown to increase cerebrovascular disease (CVD) risk in advanced-stage head-and-neck cancer. We assessed whether more limited neck RT used for early-stage (T1-T2 N0) glottic cancer is associated with increased CVD risk, using the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database.
We identified patients ≥66 years of age with early-stage glottic laryngeal cancer from SEER diagnosed from 1992 to 2007. Patients treated with combined surgery and RT were excluded. Medicare CPT codes for carotid interventions, Medicare ICD-9 codes for cerebrovascular events, and SEER data for stroke as the cause of death were collected. Similarly, Medicare CPT and ICD-9 codes for peripheral vascular disease (PVD) were assessed to serve as an internal control between treatment groups.
A total of 1413 assessable patients (RT, n=1055; surgery, n=358) were analyzed. The actuarial 10-year risk of CVD was 56.5% (95% confidence interval 51.5%-61.5%) for the RT cohort versus 48.7% (41.1%-56.3%) in the surgery cohort (P=.27). The actuarial 10-year risk of PVD did not differ between the RT (52.7% [48.1%-57.3%]) and surgery cohorts (52.6% [45.2%-60.0%]) (P=.89). Univariate analysis showed an increased association of CVD with more recent diagnosis (P=.001) and increasing age (P=.001). On multivariate Cox analysis, increasing age (P<.001) and recent diagnosis (P=.002) remained significantly associated with a higher CVD risk, whereas the association of RT and CVD remained not statistically significant (HR=1.11 [0.91-1.37,] P=.31).
Elderly patients with early-stage laryngeal cancer have a high burden of cerebrovascular events after surgical management or RT. RT and surgery are associated with comparable risk for subsequent CVD development after treatment in elderly patients.
综合颈部放射治疗（RT）已被证明会增加晚期头颈部癌症患者的脑血管疾病（CVD）风险。我们使用监测、流行病学和最终结果（SEER）-医疗保险数据库评估了用于早期（T1-T2 N0）声门型喉癌的更有限的颈部 RT 是否与增加的 CVD 风险相关。
我们从 1992 年至 2007 年诊断的 SEER 中确定了年龄≥66 岁的早期声门型喉癌患者。排除接受联合手术和 RT 治疗的患者。收集了颈动脉介入治疗的 Medicare CPT 代码、脑血管事件的 Medicare ICD-9 代码和作为死亡原因的中风 SEER 数据。同样，评估了 Medicare CPT 和 ICD-9 代码用于外周血管疾病（PVD），以作为治疗组之间的内部对照。
共分析了 1413 例可评估患者（RT 组 1055 例；手术组 358 例）。RT 组的 10 年 CVD 累积发生率为 56.5%（95%置信区间 51.5%-61.5%），手术组为 48.7%（41.1%-56.3%）（P=.27）。RT 组（52.7%[48.1%-57.3%]）和手术组的 10 年 PVD 累积发生率无差异（52.6%[45.2%-60.0%]）（P=.89）。单因素分析显示，CVD 与最近诊断（P=.001）和年龄增加（P=.001）呈正相关。多变量 Cox 分析显示，年龄增加（P<.001）和最近诊断（P=.002）与 CVD 风险增加显著相关，而 RT 与 CVD 之间的关联仍无统计学意义（HR=1.11 [0.91-1.37]，P=.31）。
接受手术治疗或 RT 的老年早期喉癌患者发生脑血管事件的负担很重。在老年患者中，RT 和手术与治疗后随后发生 CVD 的风险相当。
