Scripties UMCG - Rijksuniversiteit Groningen
English | Nederlands

Risk of anterior circulation ischemic cerebrovascular events after curative (chemo)radiotherapy for head and neck cancer is associated with carotid artery radiation dose

(2018) Aken, E.S.M. van

Background and objective: Radiotherapy in the head and neck area may cause vascular damage to the carotid arteries, increasing the risk of ischemic cerebrovascular events (ICVEs). However, little information is available about the dose-effect relationship, which is essential to identify patients at risk and to optimize radiotherapy treatment plans. The purpose of this study was to determine the relationship between radiation dose to the carotid arteries and anterior circulation ICVE risk and to identify the most relevant dose-volume parameters.
Materials and methods: A retrospective analysis was performed using data of a prospective cohort study of 750 patients treated with definitive radiotherapy (either or not combined with systemic treatment) for head and neck squamous cell carcinomas. Based on treatment planning CT scans, carotid arteries were delineated and dose-volume parameters were calculated. ICVEs were scored by patient record analysis. Cox proportional hazards analysis was performed to analyse the relationship between radiation dose and ICVE risk.
Results: Anterior circulation ICVE risk was significantly associated with the absolute volume (cm3) of the carotid arteries that receives at least a radiation dose of 10 Gy (hazard ratio 1.14; p<0.001). The common carotid artery (CCA) and the bifurcation were the most relevant portions of the carotid artery for ICVE risk estimation. No relevant confounding patient and treatment characteristics were found.
Conclusions: This is the first study that demonstrates an independent dose-effect relationship between radiation dose to the carotid arteries and the risk of anterior circulation ICVE. These findings may lead to more adequate ICVE risk prediction and prevention in these patients.

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