Carotid stenosis after radiotherapy for nasopharyngeal carcinoma

Arch Otolaryngol Head Neck Surg. 2000 Apr;126(4):517-21. doi: 10.1001/archotol.126.4.517.


Objective: To determine the prevalence and risk factors for radiation-induced carotid stenosis in patients with malignant neoplasms of the head and neck.

Design: Prospective cross-sectional screening of extracranial carotid stenosis by color-flow duplex ultrasonography with an analysis of demographic and comorbid risk factors.

Setting: Tertiary oncology and vascular referral center.

Patients: The study included 96 consecutive patients (75 men and 21 women; mean age, 53.6 years) who had undergone cervical radiotherapy (RT) for nasopharyngeal carcinoma more than 12 months ago. The mean post-RT interval was 79.9 months. Fourteen patients had cerebrovascular symptoms. A group of 96 healthy individuals were used as controls.

Main outcome measures: Internal carotid stenosis and common carotid artery stenosis were classified by duplex ultrasonography into moderate (30%-69%), severe (70%-99%), and totally occlusive.

Results: Internal carotid artery stenosis of 70% or more was detected in 14 arteries in 12 patients (6 occlusions). Common carotid artery stenosis of 70% or more was found in 11 arteries in 9 patients (4 occlusions). Overall, 15 patients (16%) had critical stenosis in their common or internal carotid arteries, and another 20 (21%) had stenosis in the moderate range. Critical carotid stenosis was not present in any of the control subjects. Severe post-RT carotid stenosis was associated with age (P = .003), smoking (P = .004), heart disease (P<.001), no prior oncological surgery (P<.001), cerebrovascular symptoms (P<.001), and interval from RT (P<.001). Smoking, interval from RT, cerebrovascular symptoms, and no head and neck surgery were significant independent predictors for severe carotid stenosis on multivariate logistic regression analysis.

Conclusions: Patients who undergo irradiation of the head and neck for more than 5 years have a higher risk of developing significant carotid stenosis (relative risk, 15), and routine duplex ultrasound screening is recommended.

MeSH terms

  • Carotid Artery, Common*
  • Carotid Artery, Internal*
  • Carotid Stenosis / diagnostic imaging
  • Carotid Stenosis / epidemiology
  • Carotid Stenosis / etiology*
  • Cross-Sectional Studies
  • Female
  • Humans
  • Logistic Models
  • Male
  • Middle Aged
  • Nasopharyngeal Neoplasms / radiotherapy*
  • Prevalence
  • Prospective Studies
  • Risk Factors
  • Sensitivity and Specificity
  • Time Factors
  • Ultrasonography, Doppler, Color