engleski

Carotid artery stenosis in patients having received radiotherapy for for nasopharyngeal carcinoma : our expirience

Carotid artery stenosis (CAS) is one of the major complications of external irradiation (radiotherapy, XRT) for nasopharyngeal carcinoma. More and more patients with head and neck cancers who had undergone radical neck dissection and adjuvant radiation are experiencing prolonged survival times. Because of their improved survival rate, patients are now living long enough to suffer the delayed effects of radiation therapy. Color duplex Doppler Flow Imagine /CDFI/ is a non-invasive method which, in wide application, brings to early detection of internal carotid artery disease. Prevalence of carotid arterial disease in patients with previous cervical radiation therapy is high enough to justify routine screening for carotid artery stenosis. Methods: Forty-two postradiation patients (33 male and 9 female ; mean age of 53.6 years) with nasopharyngeal carcinoma were examined with Color Duplex Doppler Ultrasound in the Neurosonology Laboratory, Neurology Department, Clinical Hospital Of Rijeka. All patients were members of Otorinolaryngology Clinic Postlaryngectomical Club, Clinical Hospital of Rijeka. Patients were divided into two groups – postiradiation patients with and without carotid stenosis. They also represented the control group. The mean follow up time after radiotherapy in the RT group was 5, 2 years and the mean dosage of irradiation was 6000 cGy in the neck area. Detailed review of cerebrovascular risk factors - such as hypertension, smoking, diabetes and hypercholesterolemia in these two groups were also monitored. Results: Duplex ultrasound scans revealed that 14 / 33, 33 % / of patients had significant radiation –induced carotid artery stenosis. Five /11, 9 % / patients had unilateral carotid occlusion, and four patients /9, 52 %/ have had a stroke after radiation trerapy. The majority (over 85, 71%) of radiation-induced CAS had more than one atherosclerotic plaqe including any degree of stenosis in the RT group, and had significantly more than that of the control group. Nine of the 14 patients having radiation induced carotid stenosis were treated using distal embolic protection devices, and underwent balloon dilation after stent placement. Conclusion: This study has shown that radiation could cause significant carotid stenosis. Patients with prior cervical XRT are a special population in which screening may be warranted. Carotid artery disease that occurs as a result of radiation therapy is considered a clear indication for endovascular therapy and carotid artery angioplasty consequently making stent placement a definitive treatment strategy for patients having received radiotherapy for nasopharyngeal carcinoma. Yearly ultrasound examinations for RT patients are therefore necessary for screening and early detection of carotid stenosis .

Carotid artery stenosis; radiotherapy; nasopharyngeal carcinoma

Organizer Association for Promotion of otorhinolaryngology in maritime and Underwater medicine