Abstract
Objective
Although low dose radiation therapy (RT) has been used to prevent re-occlusion of
coronary arteries, it may also precipitate vascular damage. Specifically, irradiation
to the neck is related to subsequent vascular wall thickening and atherosclerotic
plaque formation. Several investigators, reporting patients with varied disease processes
and using different methods, have described an increased risk of cerebrovascular events
(CVEs) after RT to the neck for head and neck cancer, breast cancer, or lymphoma.
Our purpose is to determine the rate and risk of CVEs in patients after receiving
radiation therapy to the neck.
Methods
We performed a pooled analysis of the published data to document the cumulative risk
of subsequent stroke after RT to the neck. An extensive MEDLINE and PUBMED search
yielded five articles involving 6908 patients describing institutional series or cohort
analyses comparing the frequency of CVE in irradiated versus non-irradiated patients.
Results
Sixty-six CVEs were reported in 2567 patients after neck RT, whereas only 12 CVEs
were documented in 4119 non-irradiated patients. Crude risk of CVEs after neck RT
was 2.6%, and was 0.29% in non-irradiated patients. This odds ratio of 9.0 was statistically
significant (95% CI 4.9, 16.7; p < 0.0001). Data for supraclavicular RT were more difficult to analyze given differences
in populations and reporting between the three studies, but it appears a significant
risk is unlikely.
Conclusions
Neck RT increases the likelihood of CVEs, but this risk must be reconciled with the
benefits of the therapy in the specific clinical situation. For instance, consideration
should be made to limiting neck RT where possible for breast cancer and lymphoma patients.
Keywords
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Article info
Publication history
Published online: January 27, 2009
Accepted:
December 31,
2008
Received in revised form:
December 30,
2008
Received:
September 30,
2008
Identification
Copyright
© 2009 Elsevier Ireland Ltd. Published by Elsevier Inc. All rights reserved.
