Taengsakul Nawaphan, Nivatpumin Padungcharn, Chotchutipan Thong, Tungfung Sunanta
Department of Surgery, Chulabhorn Hospital, Princess Srisavangavadhana College of Medicine, Chulabhorn Royal Academy, Bangkok, Thailand.
Department of Radiation Oncology, Chulabhorn Hospital, Chulabhorn Royal Academy, Bangkok, Thailand.
PLoS One. 2025 Jan 30;20(1):e0314861. doi: 10.1371/journal.pone.0314861. eCollection 2025.
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. We enrolled 907 patients with HNC who underwent radiotherapy between February 2011 and June 2022 and obtained information on their clinical and tumor characteristics and their treatment from the clinical records. Data on risk factors for atherosclerosis, medications used, and radiotherapy were also collected. The patients were followed through to the end of 2023 unless they died or were lost to follow-up. The overall incidence of ICVE was 1.98%, with a cumulative incidence of 1.65% over 5 years. In patients who did not have a preexisting carotid artery lesion, the cumulative incidence of significant CAS was 1.3% at 12 months, 2.2% at 24 months, and 2.5% at 36 months post-radiotherapy. The most important risk factors for new CAS were age >65 years (aHR = 2.60, p = 0.008, 95% confidence Interval: 1.28-5.30), laryngeal cancer (aHR = 2.36, p<0.017, 95% confidence Interval: 1.01-5.55), and total plaque score (aHR = 1.38, p<0.001, 95% confidence Interval: 1.23-1.56). There was a significant increase in stenosis, plaque score, and wall thickness in all areas in the carotid artery (p<0.001). The incidence of ICVE and the cumulative incidence of CAS was found to be lower in the Thai population than in other populations. The main risk factors for new CAS were age >65 years, laryngeal cancer, and total plaque score. Changes in the carotid artery were detected early and affected all areas in the artery. Patients with HNC treated by radiotherapy should be assessed for risk factors for CAS and undergo vascular surveillance during follow-up.
放射治疗是头颈癌（HNC）患者的主要治疗方法，且与缺血性脑血管事件（ICVE）风险增加相关。这项横断面研究的目的是确定接受放射治疗的HNC患者中ICVE和颈动脉狭窄（CAS）的发生率以及CAS的危险因素。我们纳入了2011年2月至2022年6月期间接受放射治疗的907例HNC患者，并从临床记录中获取了他们的临床和肿瘤特征以及治疗信息。还收集了动脉粥样硬化危险因素、所用药物和放射治疗的数据。患者随访至2023年底，除非死亡或失访。ICVE的总体发生率为1.98%，5年累积发生率为1.65%。在既往无颈动脉病变的患者中，放疗后12个月时显著CAS的累积发生率为1.3%，24个月时为2.2%，36个月时为2.5%。新CAS的最重要危险因素为年龄>65岁（调整后风险比[aHR]=2.60，p=0.008，95%置信区间：1.28 - 5.30）、喉癌（aHR=2.36，p<0.017，95%置信区间：1.01 - 5.55）和总斑块评分（aHR=1.38，p<0.001，95%置信区间：1.23 - 1.56）。颈动脉所有区域的狭窄、斑块评分和管壁厚度均显著增加（p<0.001）。发现泰国人群中ICVE的发生率和CAS的累积发生率低于其他人群。新CAS的主要危险因素为年龄>65岁、喉癌和总斑块评分。颈动脉变化在早期即可检测到，且影响动脉的所有区域。接受放射治疗的HNC患者应评估CAS的危险因素，并在随访期间接受血管监测。
