Stroke After Radiation Therapy for Head and Neck Cancer: What Is the Risk?
| Autor: | Stephen F. Hall, K. Zaza, Yingwei Peng, Erin Arthurs, Timothy P. Hanna |
|---|---|
| Rok vydání: | 2016 |
| Předmět: |
Adult
Male Cancer Research medicine.medical_specialty medicine.medical_treatment Population Comorbidity Risk Assessment 03 medical and health sciences 0302 clinical medicine Internal medicine medicine Humans Radiology Nuclear Medicine and imaging Registries Radiation Injuries education Survival rate Stroke Aged Ontario education.field_of_study Radiation Squamous Cell Carcinoma of Head and Neck business.industry Incidence Hazard ratio Head and neck cancer Middle Aged medicine.disease Cancer registry Surgery Causality Survival Rate Radiation therapy Treatment Outcome Oncology Head and Neck Neoplasms 030220 oncology & carcinogenesis Carcinoma Squamous Cell Female business 030217 neurology & neurosurgery Cohort study |
| Zdroj: | International Journal of Radiation Oncology*Biology*Physics. 96:589-596 |
| ISSN: | 0360-3016 |
| DOI: | 10.1016/j.ijrobp.2016.07.007 |
| Popis: | Purpose A retrospective population-based cohort study was conducted to determine the risk of ischemic stroke with respect to time, associated with curative radiation therapy in head and neck squamous cell carcinomas (HNSCC). Methods and Materials On the basis of data from the Ontario Cancer Registry and regional cancer treatment centers, 14,069 patients were identified with diagnoses of squamous cell carcinoma of the oral cavity, larynx, and pharynx who were treated for cure between 1990 and 2010. Hazards of stroke and time to stroke were examined, accounting for the competing risk of death. Stroke risk factors identified through diagnostic and procedural administrative codes were adjusted for in the comparison between treatment regimens, which included surgery alone versus radiation therapy alone and surgery alone versus any exposure to radiation therapy. Results Overall, 6% of patients experienced an ischemic stroke after treatment, with 5% experiencing a stroke after surgery, 8% after radiation therapy alone, and 6% after any exposure to radiation therapy. The cause-specific hazard ratios of ischemic stroke after radiation therapy alone and after any exposure to radiation therapy compared with surgery were 1.70 (95% confidence interval [CI]: 1.41-2.05) and 1.46 (95% CI: 1.23-1.73), respectively, after adjustment for stroke risk factors, patient factors, and disease-related factors. Conclusions Radiation therapy was associated with an increased risk of ischemic stroke compared with surgery alone: for both radiation therapy alone and after all treatment modalities that included any radiation treatment were combined. Because of a shift toward a younger HNSCC patient population, our results speak to the need for adequate follow-up and survivorship care among patients who have been treated with radiation therapy. Advances in treatment that minimize chronic morbidity also require further evaluation. |
| Databáze: | OpenAIRE |
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