Retrospective cohort study of long-term risk of carotid stenosis disease after radiotherapy for head and neck cancer

Recipients of radiotherapy (RT) for head and neck cancer (HNC) are at increased risk for carotid artery stenosis (CAS). However, carotid artery screening is not routinely performed among HNC survivors after RT. A retrospective cohort study at Duke Cancer Center (Durham, NC) screened HNC patients within two years after RT and every 3 years thereafter. Among 628 patients undergoing curative intent RT for HNC, with a median follow-up of 4.8 years, actuarial 10-year incidences of asymptomatic and symptomatic CAS were 29.6% and 10.1%. There was a significant association between asymptomatic CAS and absolute carotid artery volume receiving ≥ 10 Gy (per ml: HR 1,09; 95% CI 1.02-1.16). The authors conclude that HNC survivors are at high risk for post-RT CAS. A dose response effect was observed for asymptomatic CAS at doses as low as 10 Gy.