Hardy Sara J, Bandyopadhyay Sanjukta, Yang Hongmei, Williams Annalynn, Gudina Abdi, Cummings Michael A, Zhang Hong, Singh Deepinder P, Chen Yuhchyau, Mohile Nimish A, Janelsins Michelle C, Milano Michael T
Department of Neurology, University of Rochester Medical Center, Rochester, NY, United States.
Department of Radiation Oncology, University of Rochester Medical Center, Rochester, NY, United States.
Front Oncol. 2023 Jun 15;13:1111764. doi: 10.3389/fonc.2023.1111764. eCollection 2023.
Head and neck cancer is a common malignancy frequently treated with chemotherapy and radiotherapy. Studies have shown an increased risk of stroke with the receipt of radiotherapy, but data on stroke-related mortality are limited, particularly in the modern era. Evaluating stroke mortality related to radiotherapy is vital given the curative nature of head and neck cancer treatment and the need to understand the risk of severe stroke in this population.
We analyzed the risk of stroke death among 122,362 patients (83,651 patients who received radiation and 38,711 patients who did not) with squamous cell carcinoma of the head and neck (HNSCC) diagnosed between 1973 and 2015 in the SEER database. Patients in radiation vs. no radiation groups were matched using propensity scores. Our primary hypothesis was that radiotherapy would increase the hazard of death from stroke. We also examined other factors impacting the hazard of stroke death, including whether radiotherapy was performed during the modern era when IMRT and modern stroke care were available as well as increased HPV-mediated cancers of the head and neck. We hypothesized that the hazard of stroke death would be less in the modern era.
There was an increased hazard of stroke-related death in the group receiving radiation therapy (HR 1.203, p = 0.006); however, this was a very small absolute increase, and the cumulative incidence function of stroke death was significantly reduced in the modern era (p < 0.001), cohorts with chemotherapy (p=0.003), males (p=0.002), younger cohorts (p<0.001) and subsites other than nasopharynx (p=0.025).
While radiotherapy for head and neck cancer increases the hazard of stroke death, this is reduced in the modern era and remains a very small absolute risk.
头颈癌是一种常见的恶性肿瘤，常采用化疗和放疗进行治疗。研究表明，接受放疗会增加中风风险，但关于中风相关死亡率的数据有限，尤其是在现代。鉴于头颈癌治疗的治愈性质以及了解该人群严重中风风险的必要性，评估与放疗相关的中风死亡率至关重要。
我们分析了1973年至2015年间在监测、流行病学和最终结果（SEER）数据库中诊断为头颈鳞状细胞癌（HNSCC）的122362例患者（83651例接受放疗的患者和38711例未接受放疗的患者）的中风死亡风险。使用倾向评分对放疗组与未放疗组的患者进行匹配。我们的主要假设是放疗会增加中风死亡的风险。我们还研究了影响中风死亡风险的其他因素，包括在可进行调强放疗（IMRT）和现代中风护理的现代时期是否进行了放疗，以及头颈部位人乳头瘤病毒（HPV）介导的癌症增加的情况。我们假设在现代时期中风死亡风险会降低。
接受放疗的组中风相关死亡风险增加（风险比1.203，p = 0.006）；然而，这是一个非常小的绝对增加，并且在现代时期（p < 0.001）、接受化疗的队列（p = 0.003）、男性（p = 0.002）、较年轻的队列（p < 0.001）以及非鼻咽部位（p = 0.025）中，中风死亡的累积发病率函数显著降低。
虽然头颈癌放疗会增加中风死亡风险，但在现代时期这种风险会降低，并且仍然是一个非常小的绝对风险。
