2382 - High-Risk Carotid Artery Ultrasound Findings in Head and Neck Cancer Survivors after Radiation Therapy: Results of a Prospective Study
Presenter(s)
R. T. Hughes1, C. H. Tegeler2, C. L. Nightingale3, A. C. Snavely4, H. D. Pacholke5,6, B. R. Chinnasami6, G. H. Sanders6, C. M. Furdui7, D. R. Soto-Pantoja8, T. C. Register9, K. E. Weaver3, and G. J. Lesser10; 1Department of Radiation Oncology, Wake Forest University School of Medicine, Winston-Salem, NC, 2Department of Neurology, Wake Forest University School of Medicine, Winston Salem, NC, 3Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston Salem, NC, 4Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston Salem, NC, 5Department of Radiation Oncology, Wake Forest University School of Medicine, Winston Salem, NC, 6Atrium Health Wake Forest Baptist Hayworth Cancer Center, High Point, NC, 7Department of Internal Medicine, Section of Molecular Medicine, Wake Forest University School of Medicine, Winston Salem, NC, 8Department of Cancer Biology, Wake Forest University School of Medicine, Winston-Salem, NC, 9Department of Pathology, Comparative Medicine, Wake Forest University School of Medicine, Winston Salem, NC, 10Department of Internal Medicine, Section of Hematology and Oncology, Wake Forest University School of Medicine, Winston Salem, NC
Purpose/Objective(s): Radiotherapy (RT) for head and neck cancer (HNC) is associated with accelerated atherosclerosis, carotid artery stenosis (CAS) and cerebrovascular. To inform future prospective studies of a screening program, we assessed multiple carotid ultrasound (CUS) imaging features in a prospective study of HNC survivors previously treated with RT.
Materials/Methods: In this prospective multi-site pilot study (NCT05490875; WFBCCC 98322), patients who completed RT for HNC at least 2 years prior with no evidence of disease were enrolled. Exclusion criteria were: history of CAS, stroke, transient ischemic attack, carotid endarterectomy/stent, prior CUS, recurrent HNC, re-irradiation, or ECOG 2+. Eligible patients underwent CUS assessment of clinically significant CAS (primary endpoint: peak systolic velocity >150 cm/s), carotid intima-media thickness (IMT), luminal diameter narrowing <2mm, occlusion, or carotid plaque >2 mm. An IMT-based relative risk of cardiovascular disease (RR CVD) adjusted for age, sex and race was calculated. The common carotid (CC), bifurcation (CB) and internal carotid (IC) arteries were delineated 1 cm above and below planning target volumes when DICOM RT treatment data were available. For midline/bilateral primary tumors, both sides of the neck were considered “ipsilateral” (IL). Data were summarized and IMT data were compared between groups using the Wilcoxon signed-rank test.
Results: Sixty patients were enrolled, 50 underwent CUS and were included in the analysis, 10 did not due technical delays with study CUS machine. Mean age was 64, the most common primary site was oropharynx (46%), and 54% were current/former smokers. The most common comorbidities were hypertension (46%), diabetes (10%), arrhythmia (8%), myocardial infarction (6%), and COPD (4%). Median RT dose was 70 Gy (interquartile range [IQR], 60-70); 36 (72%) of patients received bilateral neck RT and 14 (28%) received unilateral RT. The median RT exposure to the carotid arteries was 61.3 Gy (IQR 57.9-65.5) for IL and 52.9 Gy (IQR 42.1-56.6) for contralateral (CL) arteries. Median time from RT to CUS was 3.1 years (IQR 2.4-4.6). Of the 50 evaluable patients, 0 patients had CAS, 9 (18%) had carotid plaque >2mm thickness, 0 had luminal diameter <2 mm or occlusion. All patients had an IMT measurement >0.9 mm and 2 (4%) were found with a RR CVD >1.5. Median IMT values were 0.993/1.424/1.165 mm for the IL IC/CB/CC and 0.998/1.321/1.058 mm for the CL IC/CB/CC. A significant difference in IMT between the IL and CL CC artery was noted in patients treated with unilateral neck RT (p=0.004); no differences between sides were noted for patients treated with bilateral neck RT.
Conclusion: In this prospective study of CUS for HNC survivors, we observed multiple instances of carotid plaque and high IMT but observed no CAS. Ongoing follow-up will determine if these findings meaningfully impact patient care. Other high-risk CUS findings may enhance detection of patients at elevated cerebro-/cardiovascular risk.