Chemoradiotherapy-related carotid artery inflammation in head and neck cancer patients quantified by [18F]FDG PET/CT

Oral Oncol. 2019 Jun;93:101-106. doi: 10.1016/j.oraloncology.2019.04.008. Epub 2019 May 1.


Objectives: Radiotherapy (RT) is associated with an increased risk of cardiovascular disease (CVD), but little is known about the mechanism for vascular injury and methods for early detection.

Materials and methods: We conducted a prospective, pilot study of carotid artery inflammation using 18F-labeled 2-fluoro-2-deoxy-d-glucose ([18F]FDG) PET/CT imaging pre- and 3 months post-RT in head-and-neck cancer (HNC) patients. [18F]FDG uptake by the carotid arteries was measured by the maximum and mean target to background ratio (TBRMAX, TBRMEAN) and the mean partial volume corrected standardized uptake value (pvcSUVMEAN).

Results: Of the 22 patients who completed both pre and post-RT scans, the majority (82%) had stage III or stage IV disease and received concurrent chemotherapy. TBRMAX, TBRMEAN, and pvcSUVMEAN were all significantly higher 3 months after RT versus before RT with mean difference values (95% CI; p-value) of 0.17 (0.1-0.25; 0.0001), 0.19 (0.12-0.25; 0.0001), and 0.31 g/ml (0.12-0.5; 0.002), respectively. Fifteen patients (68%) had HPV-positive tumors, which were associated with lower pre-RT [18F]FDG signal, but a greater increase in TBRMAX (19% vs 5%), TBRMEAN (21% vs 11%) and pvcSUVMEAN (20% increase vs 3% decrease), compared to HPV negativity.

Conclusion: There is a significant increase in carotid artery inflammation in HNC patients due to CRT that amounts to a degree that has previously been associated with higher risk for future CVD events. The subset of patients with HPV-positive tumors experienced the greatest increases in vascular inflammation due to CRT. Carotid [18F]FDG uptake may be an early biomarker of RT-related vascular injury.

Keywords: Fluorodeoxyglucose (FDG); Head and neck cancer; Inflammation; PET/CT imaging; Radiation therapy.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Aged
  • Arteritis / diagnostic imaging*
  • Carotid Arteries / diagnostic imaging*
  • Chemoradiotherapy / adverse effects*
  • Female
  • Fluorodeoxyglucose F18 / administration & dosage
  • Head and Neck Neoplasms / diagnostic imaging
  • Head and Neck Neoplasms / pathology
  • Head and Neck Neoplasms / therapy*
  • Humans
  • Male
  • Middle Aged
  • Neoplasm Staging
  • Pilot Projects
  • Positron Emission Tomography Computed Tomography
  • Prospective Studies


  • Fluorodeoxyglucose F18