Total plaque score helps to determine follow-up strategy for carotid artery stenosis progression in head and neck cancer patients after radiation therapy

• Published in: PloS one 2021-02, Vol.16 (2), p.e0246684
• Main Authors: Liu, Chi-Hung, Chang, Joseph Tung-Chieh, Lee, Tsong-Hai, Chang, Pi-Yueh, Chang, Chien-Hung, Wu, Hsiu-Chuan, Chang, Ting-Yu, Huang, Kuo-Lun, Lin, Chien-Yu, Fan, Kang-Hsing, Chu, Chan-Lin, Chang, Yeu-Jhy
• Format: Article
• Language: English
• Subjects: Arteries; Arteriosclerosis; Atherosclerosis; Auroral kilometric radiation; Biology and Life Sciences; Cancer therapies; Care and treatment; Carotid arteries; Carotid artery; Drug dosages; Flow velocity; Head & neck cancer; Head and neck cancer; Health risks; Hospitals; Ischemia; Laboratories; Medical schools; Medicine; Medicine and Health Sciences; Monitoring; Neurology; Oncology; Patient outcomes; Patients; Plaques; Radiation; Radiation therapy; Radiotherapy; Stenosis; Stroke; Ultrasonic imaging; Vascular diseases; Veins & arteries
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0246684

To identify predictors of carotid artery stenosis (CAS) progression in head and neck cancer (HNC) patients after radiation therapy (RT). We included 217 stroke-naïve HNC patients with mild carotid artery stenosis after RT in our hospital. These patients underwent annual carotid duplex ultrasound (CDU) studies to monitor CAS progression. CAS progression was defined as the presence of ≥50% stenosis of the internal/common carotid artery on follow-up CDU. We recorded total plaque score (TPS) and determined the cut-off TPS to predict CAS progression. We categorized patients into high (HP) and low plaque (LP) score groups based on their TPS at enrolment. We analyzed the cumulative events of CAS progression in the two groups. The TPS of the CDU study at enrolment was a significant predictor for CAS progression (adjusted odds ratio [aOR] = 1.69, p = 0.002). The cut-off TPS was 7 (area under the curve: 0.800), and a TPS ≥ 7 strongly predicted upcoming CAS progression (aOR = 41.106, p = 0.002). The HP group had a higher risk of CAS progression during follow-up (adjusted hazard ratio = 6.15; 95% confident interval: 2.29-16.53) in multivariable Cox analysis, and also a higher trend of upcoming ischemic stroke (HP vs. LP: 8.3% vs. 2.2%, p = 0.09). HNC patients with a TPS ≥ 7 in any CDU study after RT are susceptible to CAS progression and should receive close monitoring within the following 2 years.