This Article Full Text Full Text (PDF) Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Save to my personal folders Download to citation manager Rights & Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Dorresteijn, L. D.A. Articles by Bartelink, H. Search for Related Content PubMed PubMed Citation Articles by Dorresteijn, L. D.A. Articles by Bartelink, H. Social Bookmarking                            What's this?

Increased Risk of Ischemic Stroke After Radiotherapy on the Neck in Patients Younger Than 60 Years

From the Department of Neuro-Oncology, Epidemiology, Head and Neck Oncology, and Radiotherapy, the Netherlands Cancer Institute/Antoni van Leeuwenhoekhuis, Amsterdam, the Netherlands.

Address reprints requests to Willem Boogerd, MD, PhD, Department of Neuro-Oncology, the Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, the Netherlands; email: newbo{at}slz.nl

PURPOSE: To estimate the risk of ischemic stroke in patients irradiated for head and neck tumors.

PATIENTS AND METHODS: The incidence of ischemic stroke was determined in 367 patients with head and neck tumors (162 larynx carcinomas, 114 pleomorphic adenomas, and 91 parotid carcinomas) who had been treated with local radiotherapy (RT) at an age younger than 60 years. Relative risk (RR) of ischemic stroke was determined by comparison with population rates from a stroke-incidence register, adjusted for sex and age. Other risk factors for stroke (hypertension, smoking, hypercholesterolemia, diabetes mellitus [DM]) were registered. The median follow-up time after RT was 7.7 years (3,011 person-years of follow-up).

RESULTS: Fourteen cases of stroke occurred (expected, 2.5; RR, 5.6; 95% confidence interval [CI], 3.1 to 9.4): eight in patients with laryngeal carcinoma (expected ,1.56; RR, 5.1; 95% CI, 2.2 to 10.1), four in pleomorphic adenoma patients (expected, 0.71; RR, 5.7; 95% CI, 1.5 to 14.5), and two in parotid carcinoma patients (expected, 0.24; RR, 8.5, 95% CI, 1.0 to 30.6). Five of six strokes in patients irradiated for a parotid tumor occurred at the ipsilateral side. Analysis of other risk factors for cerebrovascular disease showed hypertension and DM to cause an increase of the RR after RT. After more than 10 years’ follow-up, the RR was 10.1 (95% CI, 4.4 to 20.0). The 15-year cumulative risk of stroke after RT on the neck was 12.0% (95% CI, 6.5% to 21.4%).

CONCLUSION: This is the first study to demonstrate an increased risk of stroke after RT on the neck. During medical follow-up, preventive measures should be taken to reduce the impact of the risk factors for cerebrovascular disease, to decrease stroke in these patients.

CiteULike    Complore    Connotea    Del.icio.us    Digg    Facebook    Reddit    Technorati    Twitter    What's this?

This article has been cited by other articles:

				M. L. De Bruin, L. D. A. Dorresteijn, M. B. van't Veer, A. D. G. Krol, H. J. van der Pal, A. C. Kappelle, W. Boogerd, B. M. P. Aleman, and F. E. van Leeuwen Increased Risk of Stroke and Transient Ischemic Attack in 5-Year Survivors of Hodgkin Lymphoma J Natl Cancer Inst, July 1, 2009; 101(13): 928 - 937. [Abstract] [Full Text] [PDF]

				D. L. Longo Late Effects From Radiation Therapy: The Hits Just Keep on Coming J Natl Cancer Inst, July 1, 2009; 101(13): 904 - 905. [Full Text] [PDF]

				M. M. Hudson, D. A. Mulrooney, D. C. Bowers, C. A. Sklar, D. M. Green, S. S. Donaldson, K. C. Oeffinger, J. P. Neglia, A. T. Meadows, and L. L. Robison High-Risk Populations Identified in Childhood Cancer Survivor Study Investigations: Implications for Risk-Based Surveillance J. Clin. Oncol., May 10, 2009; 27(14): 2405 - 2414. [Abstract] [Full Text] [PDF]

				G. L. Smith, B. D. Smith, T. A. Buchholz, S. H. Giordano, A. S. Garden, W. A. Woodward, H. M. Krumholz, R. S. Weber, K.-K. Ang, and D. I. Rosenthal Cerebrovascular Disease Risk in Older Head and Neck Cancer Patients After Radiotherapy J. Clin. Oncol., November 1, 2008; 26(31): 5119 - 5125. [Abstract] [Full Text] [PDF]

				K. A. Meeske and M. B. Nelson The Role of the Long-Term Follow-up Clinic in Discovering New Emerging Late Effects in Adult Survivors of Childhood Cancer Journal of Pediatric Oncology Nursing, July 1, 2008; 25(4): 213 - 219. [Abstract] [PDF]

				S. M. Shankar, N. Marina, M. M. Hudson, D. C. Hodgson, M. J. Adams, W. Landier, S. Bhatia, K. Meeske, M. H. Chen, K. E. Kinahan, et al. Monitoring for Cardiovascular Disease in Survivors of Childhood Cancer: Report From the Cardiovascular Disease Task Force of the Children's Oncology Group Pediatrics, February 1, 2008; 121(2): e387 - e396. [Abstract] [Full Text] [PDF]

				M. J. Hooning, L. D.A. Dorresteijn, B. M.P. Aleman, A. C. Kappelle, J. G.M. Klijn, W. Boogerd, and F. E. van Leeuwen Decreased Risk of Stroke Among 10-Year Survivors of Breast Cancer J. Clin. Oncol., December 1, 2006; 24(34): 5388 - 5394. [Abstract] [Full Text] [PDF]

				F. Milliat, A. Francois, M. Isoir, E. Deutsch, R. Tamarat, G. Tarlet, A. Atfi, P. Validire, J. Bourhis, J.-C. Sabourin, et al. Influence of Endothelial Cells on Vascular Smooth Muscle Cells Phenotype after Irradiation: Implication in Radiation-Induced Vascular Damages Am. J. Pathol., October 1, 2006; 169(4): 1484 - 1495. [Abstract] [Full Text] [PDF]

				R. Jagsi, K. A. Griffith, T. Koelling, R. Roberts, and L. J. Pierce Stroke Rates and Risk Factors in Patients Treated With Radiation Therapy for Early-Stage Breast Cancer J. Clin. Oncol., June 20, 2006; 24(18): 2779 - 2785. [Abstract] [Full Text] [PDF]

				S. J. Wong, M. Machtay, and Y. Li Locally Recurrent, Previously Irradiated Head and Neck Cancer: Concurrent Re-Irradiation and Chemotherapy, or Chemotherapy Alone? J. Clin. Oncol., June 10, 2006; 24(17): 2653 - 2658. [Abstract] [Full Text] [PDF]

				E. C. Moser, E. M. Noordijk, F. E. van Leeuwen, S. le Cessie, J. W. Baars, J. Thomas, P. Carde, J. H. Meerwaldt, M. van Glabbeke, and H. C. Kluin-Nelemans Long-term risk of cardiovascular disease after treatment for aggressive non-Hodgkin lymphoma Blood, April 1, 2006; 107(7): 2912 - 2919. [Abstract] [Full Text] [PDF]

				L. D. Dorresteijn, F. A. Stewart, and W. Boogerd Stroke As a Late Treatment Effect of Hodgkin's Disease J. Clin. Oncol., March 20, 2006; 24(9): 1480 - 1480. [Full Text] [PDF]

				F. A. Stewart, S. Heeneman, J. te Poele, J. Kruse, N. S. Russell, M. Gijbels, and M. Daemen Ionizing Radiation Accelerates the Development of Atherosclerotic Lesions in ApoE-/- Mice and Predisposes to an Inflammatory Plaque Phenotype Prone to Hemorrhage Am. J. Pathol., February 1, 2006; 168(2): 649 - 658. [Abstract] [Full Text] [PDF]

				D. C. Bowers, D. E. McNeil, Y. Liu, Y. Yasui, M. Stovall, J. G. Gurney, M. M. Hudson, S. S. Donaldson, R. J. Packer, P. A. Mitby, et al. Stroke As a Late Treatment Effect of Hodgkin's Disease: A Report From the Childhood Cancer Survivor Study J. Clin. Oncol., September 20, 2005; 23(27): 6508 - 6515. [Abstract] [Full Text] [PDF]

				D. M. Cestari, D. M. Weine, K. S. Panageas, A. Z. Segal, and L. M. DeAngelis Stroke in patients with cancer: Incidence and etiology Neurology, June 8, 2004; 62(11): 2025 - 2030. [Abstract] [Full Text] [PDF]

				A. Davies Oral medicine Palliative Medicine, September 1, 2003; 17(6): 554 - 555. [PDF]

				J C Wadsley, M Patel, C D C Tomlins, and J Q Gildersleve Iridium-192 implantation for T1 and T2a carcinoma of the tongue and floor of mouth: retrospective study of the results of treatment at the Royal Berkshire Hospital Br. J. Radiol., June 1, 2003; 76(906): 414 - 417. [Abstract] [Full Text] [PDF]

				L. Licitra, C. Grandi, M. Guzzo, L. Mariani, S. L. Vullo, F. Valvo, P. Quattrone, P. Valagussa, G. Bonadonna, R. Molinari, et al. Primary Chemotherapy in Resectable Oral Cavity Squamous Cell Cancer: A Randomized Controlled Trial J. Clin. Oncol., January 15, 2003; 21(2): 327 - 333. [Abstract] [Full Text] [PDF]