Screening for irradiation vasculopathy by intima-media thickness sonography in head and neck cancer patients
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HEAD AND NECK
Screening for irradiation vasculopathy by intima‑media thickness sonography in head and neck cancer patients D. Strüder1 · S. Hellwig1 · H. Rennau2 · S. van Bonn1 · S. P. Schraven1 · R. Mlynski1 · G. Hildebrandt2 · T. Schuldt1 Received: 7 July 2020 / Accepted: 15 August 2020 © The Author(s) 2020
Abstract Purpose Post-irradiation vasculopathy is a severe form of atherosclerosis and affects the prognosis of head and neck cancer survivors. Sonographic intima-media thickness (IMT) precedes stenosis, plaque formation, and cerebrovascular events. Therefore, IMT may be a valuable screening marker for post-irradiation toxicity. However, the critical irradiation dose and the onset of IMT increase remain unclear. Methods The cross-sectional study analysed the carotid artery IMT in 96 irradiated patients and 41 controls regarding irradiation dose, post-irradiation-interval, and cardiovascular risk factors. Distinct irradiation doses to the tumour side and the contralateral hemineck enabled detection of dose depended effects within one patient and control of risk factors. Results Radiotherapy caused a dose-dependent increase in IMT. The toxicity did not have saturation effects for > 60 Gy. The IMT increase occurred in short-term following radiotherapy and the risk for a pathological value (> 0.9 mm) rose significantly. The correlation between IMT and radiotherapy was comparable to established cardiovascular risk factors. Conclusion Radiotherapists should consider the additional toxicity of high doses for non-metastatic head and neck cancer. If neck metastases require radiotherapy with boost, IMT measurement is suitable for early detection of carotid artery damage. Keywords Atherosclerosis · Radiotherapy · Stenosis · Ultrasonography · Cardiovascular risk Abbreviations Gy Gray HNSCC Head and neck squamous cell cancer IMT Intima-media thickness RT Radiotherapy
Introduction Radiotherapy is an integral part of head and neck squamous cell cancer (HNSCC) therapy. In particular, for human papillomavirus-related oropharyngeal cancer, high dose radiotherapy (RT) enables 5-year overall survival rates of up to 95% [1–4]. However, the improving outcome and lack of dose de-escalation strategies put the patients at risk for * D. Strüder [email protected]‑rostock.de 1
Department of Oto‑Rhino‑Laryngology, Head and Neck Surgery “Otto Koerner”, Rostock University Medical Center, Rostock, Germany
Department of Radiotherapy and Radiation Oncology, Rostock University Medical Centre, Rostock, Germany
2
long-term RT-related complications [5, 6]. Post-RT vasculopathy is a common side-effect causing fibrosis (damage to vasa vasorum), platelet aggregation (damage to endothelium), and foam-cell formation (inflammation) [7–10]. PostRT vasculopathy results in a severe form of atherosclerosis and significantly increases the cerebrovascular risk [7, 8, 10–14]. Carotid artery stenosis results in 18–40% and the relative risk of stroke increases by five compared to healthy controls and non-irradiated cancer patients [
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