Friedlander A H, August M
Oral and Maxillofacial Surgery Service, Veterans Affairs Medical Center, Sepulveda, Calif., USA.
Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1998 Mar;85(3):339-44. doi: 10.1016/s1079-2104(98)90020-8.
Therapeutic irradiation of the neck is a common component of treatment for those with carcinoma of the oral cavity, pharynx, and larynx. Such irradiation, however, has been implicated as the cause of accelerated atherosclerosis of the cervical carotid artery and subsequent stroke. Panoramic radiography, previously shown to be capable of identifying carotid artery atherosclerosis in non-irradiated individuals, was used to assess the carotid vasculature of patients who had been treated for cancer with therapeutic irradiation.
The panoramic radiographs of 33 male subjects who had received therapeutic irradiation (> or = 50 Gy) to the neck 30 or more months previously were assessed for the presence of calcified carotid artery atherosclerotic lesions. Age-matched controls, similarly liable for oropharyngeal malignancy and atherosclerosis by virtue of their medical and habitual risk factors (hypertension, smoking, obesity) were assessed in a like manner.
The panoramic radiographs of the irradiation-treated subjects (age range, 32 to 84 years; mean age, 66.1 years) showed that 21% (7 of 33 subjects) had calcified atherosclerotic lesions. The mean age of these seven subjects was 64.6 years; four had unilateral lesions and three had bilateral lesions. The radiographs of the control subjects showed that 4.7% (5 of 107 subjects) had calcified atherosclerotic lesions. The mean age of these five subjects was 67; three had unilateral lesions and two had bilateral lesions. The lesions seen in the two populations had similar morphologic appearances. The discrete radiopaque calcifications were located within the soft tissues of the neck, approximately 2.5 cm inferior-posterior to the angle of the mandible.
Subjects who had received therapeutic irradiation of the neck had a statistically higher risk (p = 0.007, according to Fisher's Exact Test) of the development of calcified carotid artery atherosclerotic lesions than age-matched, risk-matched, non-irradiated control subjects. These lesions can be detected on routine panoramic radiographs.
颈部治疗性放射是口腔、咽和喉癌患者治疗的常见组成部分。然而，这种放射被认为是导致颈总动脉加速动脉粥样硬化及随后中风的原因。全景X线摄影先前已被证明能够识别未接受放射的个体中的颈动脉粥样硬化，本研究使用该方法评估接受过癌症治疗性放射的患者的颈动脉脉管系统。
对33名男性受试者的全景X线片进行评估，这些受试者在30个月或更长时间之前接受过颈部治疗性放射（≥50 Gy），以检查是否存在钙化的颈动脉粥样硬化病变。以同样的方式对年龄匹配的对照组进行评估，这些对照组由于其医学和习惯风险因素（高血压、吸烟、肥胖）同样易患口咽恶性肿瘤和动脉粥样硬化。
接受放射治疗的受试者（年龄范围32至84岁；平均年龄66.1岁）的全景X线片显示，21%（33名受试者中的7名）有钙化的动脉粥样硬化病变。这7名受试者的平均年龄为64.6岁；4名有单侧病变，3名有双侧病变。对照组受试者的X线片显示，4.7%（107名受试者中的5名）有钙化的动脉粥样硬化病变。这5名受试者的平均年龄为67岁；3名有单侧病变，2名有双侧病变。两组人群中所见病变的形态学外观相似。离散的不透射线钙化位于颈部软组织内，在下颌角后下方约2.5 cm处。
与年龄匹配、风险匹配的未接受放射的对照组受试者相比，接受颈部治疗性放射的受试者发生钙化的颈动脉粥样硬化病变的风险在统计学上更高（根据Fisher精确检验，p = 0.007）。这些病变可在常规全景X线片上检测到。
