The role of modern methods of imaging carotid artery stenosis occurring as a late post-radiation effect after radiotherapy for head and neck cancer.
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Keywords

Carotid artery stenosis, duplex ultrasound, digital subtraction angiography, computed tomography angiography, magnetic resonance angiography

How to Cite

Zuzanna Płazińska, and Jolanta Tomczak. 2025. “The Role of Modern Methods of Imaging Carotid Artery Stenosis Occurring As a Late Post-Radiation Effect After Radiotherapy for Head and Neck Cancer”. Letters in Oncology Science 22 (1). https://doi.org/10.21641/los.2025.22.1.258.

Abstract

Abstract

Head and neck cancer is an increasingly diagnosed cancer among oncology patients around the world. Due to the location and severity in many cases the most frequently used treatment method is radiotherapy. The highly toxic radiation beam damages not only tissues affected by cancer but also healthy tissues, including blood vessels located close to the clinical target volume. Carotid artery stenosis appears as a late side effect of radiation treatment for head and neck cancer. Stenosis of the carotid artery is associated with increased risk of ischemic stroke, therefore routine screening is important. Diagnostic modalities used for screening include DUS, DSA, CTA, MRA and PET/CT. Doppler ultrasonography is the method of choice for assessing carotid artery stenosis.

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References

[1] Gormley M, Creaney G, Schache A, Ingarfield K, Conway DI. Reviewing the epidemiology of head and neck cancer: definitions, trends and risk factors. Br Dent J. 2022; 233(9): 780-786.

[2] Shun Leung W, Ming Hung H. Treatment of Head and Neck Cancers Using Radiotherapy. Dosimetry. IntechOpen; Mar 2022; Available from: http://dx.doi.org/10.5772/intechopen.103678

[3] Leung HWC, Wang SY, Lin CL, Chan ALF. Radiation Dose-Induced Carotid Artery Stenosis and Brain Necrosis in Head and Neck Cancer-A Real World Cohort Study. Cancers (Basel). 2024 Aug 27;16(17):2982.

[4] Salik M, Bakir EP. Dental caries and demineralization in head and neck cancer patients undergoing radiotherapy. J Dent Sci. 2024; 2(1):24-29.

[5] Bąk B, Adamska A. Innowacyjne metody wykorzystywane w radioterapii. Ogólnopolski Przegląd Medyczny. 6. 18-22.

[6] Brook I. Early side effects of radiation treatment for head and neck cancer. Cancer Radiother. 2021 Jul;25(5):507-513.

[7] Brook I. Late side effects of radiation treatment for head and neck cancer. Radiat Oncol J. 2020 Jun;38(2):84-92.

[8] Randolph W, Dains JE. Ultrasound Evaluation of Carotid Artery Intima-Media Thickness: Effective Early Marker of Carotid Artery Disease in Adult Head and Neck Cancer Patients After Neck Radiation? J Adv Pract Oncol. 2022 Sep; 13(7): 683-694.

[9] Brouwer CL, Steenbakkers RJ, Bourhis J, Budach W, Grau C, Grégoire V, et al. CT-based delineation of organs at risk in the head and neck region: DAHANCA, EORTC, GORTEC, HKNPCSG, NCIC CTG, NCRI, NRG Oncology and TROG consensus guidelines. Radiother Oncol. 2015 Oct;117(1):83-90.

[10] Song J, Lan L, Lv Y, Wen Y, Kang M, Wang R. Study on carotid artery stenosis after radiotherapy for nasopharyngeal carcinoma. J Cancer Res Clin Oncol. 2024 May 25;150(5):273.

[11] Kuo DY, Wu YW, Hsieh CH, Liao LJ, Shueng PW. Application of Carotid Duplex Ultrasonography in the Surveillance of Carotid Artery Stenosis after Neck Irradiation. Rev Cardiovasc Med. 2022 Jun 27;23(7):240.

[12] Delman A, Griffin MT, Werner TJ, Alavi A, Raynor WY, Rootwell-Revheim ME. The emerging role of positron emission tomography (PET) in the management of photon radiotherapy-induced vasculitis in head and neck cancer patients. Clin Transl Imaging. 2023 Feb; 11(2):157-164.

[13] Arthurus E, Hanna TP, Zaza K, Peng Y, Hall SF. Stroke after Radiotherapy for Head and Neck Cancer – What is the Risk? Int J Radiat Oncol Biol Phys. 2016 Jul;96(3):589-596

[14] Adla T, Adlova R. Multimodality Imaging of Carotid Stenosis. Int J Angiol. 2015 Sep; 24(3): 179-184.

[15] Ravikanth R. Role of 18F-FDG positron emission tomography in carotid atherosclerotic plaque imaging: A systematic review. World J Nuc Med. 2020 Oct-Dec; 19(4): 327-335.

[16] Madycki G, Gabriel M, Hawro P, Pawlaczyk K, Kuczmik W, Urbanek T. Zalecenia dotyczące wykonywania badań USG dupleks Dopler tętnic szyjnych i kręgowych Polskiego Towarzystwa Chirurgii Naczyniowej. Kardiologia Polska. 2024; 72 3: 288-309.

[17] Editor's Choice – European Society for Vascular Surgery (ESVS) 2023 Clinical Practice Guidelines on the Management of Atherosclerotic Carotid and Vertebral Artery Disease

Naylor, RossESVS Guidelines Committee, Document Reviewers, et al. European Journal of Vascular and Endovascular Surgery, Volume 65, Issue 1, 7 – 111 Dostęp 31.12.2024

[18] Saxena A, Ng EYK, Lim ST. Imaging modalities to diagnose carotid artery stenosis: progress and prospect. Biomed Eng Online. 2019 May;18(1):66

[19] Strüder D, Hellwig S, Rennau H, van Bonn S, Schraven SP, Mlynski R, et al. Screening for irradiation vasculopathy by intima-media thickness sonography in head and neck cancer patients. Eur Arch Otorhinolaryngol. 2021 Jun;278(6):2017-2026.

[20] David E, Grazhdani H, Aliotta L, Gavazzi LM, Foti PV, Palmucci S, et al. Imaging of Carotid Stenosis: Where Are We Standing? Comparison of Multiparametric Ultrasound, CT Angiography, and MRI Angiography, with Recent Developments. Diagnostics. 2024 Aug; 14(16):1708

[21] Daolio RM, Zanin LFS, Flumignan CDQ, Cassola N, Guedes Neto HJ, Santos JEM, et al. Accuracy of duplex ultrasonography versus angiotomography for the diagnosis of extracranial internal carotid stenosis. Rev Col Bras Cir. 2024 Jun 14;51:e20243632.

[22] Cui H, Yan R, Zhai Z, Ren J, Li Z, et al. Comparative analysis of 3D time-resolved contrast-enhanced magnetic resonance angiography, color Doppler ultrasound and digital subtraction angiography in symptomatic carotid stenosis. Exp Ther Med. 2018 Feb;15(2): 1654-1659.

[23] Banaei A. The Comparison between Digital Subtraction Angiography, CT Angiography, and Doppler Ultrasonography in Evaluation and Assessment of Carotid Artery Stenosis. AMHSR. 2017 Mar;15: e61661.

[24] Simaan N, Jubeh T, Beiruti KW, Sharabi-Nov A, Honig A, Shahien R. Comparison of Doppler Ultrasound and Computerized Tomographic Angiography in Evaluation of Cervical Arteries Stenosis in Stroke Patients, a Retrospective Single-Center Study. Diagnostics. 2023 Jan;26;13(3):459.

[25] Müller M, Agten C, Oesterreich M, Hoffmann M. Assessing internal carotid artery stenosis with a semiautomated computed tomography angiography tool and duplex ultrasound. J Vasc Surg. 2015 Jun;61(6):1449-56.

[26] Atlı E, Uyanık SA, Öğüşlü U, Çevik Cenkeri H, Yılmaz B, Gümüş B. Radiation doses from head, neck, chest and abdominal CT examinations: an institutional dose report. Diagn Interv Radiol. 2021 Jan;27(1):147-151.

[27] Reddy DG, Malini KP, Marrapu AK, Patnala A. Imaging Modalities to Diagnose Carotid Artery Occlusion. Journal of Children s Health. 2024 Apr; 14(2):2251-6727

[28] Tzimkas-Dakis K, Nana P, Chaidoulis A, Spanos K, Konstantinos B, Giannoukas AD, et al. Carotid Plaque Vulnerability Diagnosis by CTA versus MRA: A Systematic Review. Diagnostics. 2023 Feb; 13(4):646.

[29] Yoshida Y, Tajima Y, Kubota M, Kobayashi E, Adachi A, Iwadate Y. Carotid Artery Stenting for Patients with Radiation-Induced Carotid Artery Stenosis. J Neuroendovasc Ther. 2022;16(12):600-605.

[30] Kelly PJ, Camps-Renom P, Giannotti N, Martí-Fàbregas J, Murphy S, McNulty J, et al. Carotid Plaque Inflammation Imaged by 18F-Fluorodeoxyglucose Positron Emission Tomography and Risk of Early Recurrent Stroke. Stroke. 2019 Jul; 50(7):1766-1773.

[31] Borja AJ, Hancin EC, Dreyfuss AD, Zhang V, Mathew T, Rojulpote C, et al. 18F-FDG-PET/CT in the quantification of photon radiation therapy-induced vasculitis. Am J Nucl Mol Imaging. 2020 Feb; 10(1): 66–73.

[32] Gargani L, Baldini M, Berchiolli R, Bort IR, Casolo G, Chiappino D, et al. Detecting the vulnerable carotid plaque: the Carotid Artery Multimodality imaging Prognostic study design. J Cardiovasc Med (Hagerstown). 2022 Jul 1;23(7):466-473

[33] Thalhammer C, Husmann M, Glanzmann C, Studer G, Amann-Vesti BR. Carotid artery disease after head and neck radiotherapy. Vasa. 2015 Jan;44(1):23-30.

[34] Texakalidis P, Giannopoulos S, Tsouknidas I, Song S, Rivet DJ, Reiter ER, et al. Prevalence of carotid stenosis following radiotherapy for head and neck cancer: A systematic review and meta-analysis. Head Neck. 2020 May;42(5):1077-1088.

[35] Gujral DM, Long M, Roe JW, Harrington KJ, Nutting CM. Standardization of target volume delineation for carotid-sparing intensity-modulated radiotherapy in early glottis cancer. Clin Oncol (R Coll Radiol). 2017 Jan;29(1):42-50.

[36] Lee E, Greco S, Chang L. Radiation-induced Carotid and Vertebral Artery Stenosis in the Intensity-modulated Radiation Therapy Era: A Case Report. Appl Rad Oncol. 2022;(2):30-34.

[37] Buciuman N, Dasu A, Marcu LG. Dosimetric evaluation of intensity modulated photon versus proton reirradiation of head and neck cancer. Phys Med. 2024 Jul;123:103427.

[38] Dorth JA, Patel PR, Broadwater G, Brizel DM. Incidence and risk factors of significant carotid artery stenosis in asymptomatic survivors of head and neck cancer after radiotherapy. Head Neck. 2014 Feb;36(2):215-9.

[39] Nieder C, Grant DM. Considerations regarding carotid artery dose in radiotherapy of the cervical spine. Clin Transl Radiat Oncol. 2022 Nov 8;38:77-80.

[40] Carpenter DJ, Patel P, Niedzwiecki D, Dillon M, Diaz AK, Kumar A, et al. Long-term risk of carotid stenosis and cerebrovascular disease after radiation therapy for head and neck cancer. Cancer. 2023 Oct 28.

[41] Gujral DM, Shah BN, Chahal NS, Senior R, Harrington KJ, Nutting CM. Clinical features of radiation-induced carotid atherosclerosis. Clin Oncol (R Coll Radiol). 2014 Feb;26(2):94-102.

[42] Carpenter DJ, Mowery YM, Broadwater G, Rodrigues A, Wisdom AJ, Dorth JA, et al. The risk of carotid stenosis in head and neck cancer patients after radiation therapy. Oral Oncol. 2018 May;80:9-15.

[43] Xu J, Cao Y. Radiation-induced carotid artery stenosis: a comprehensive review of the literature. Interv Neurol. 2014 Aug;2(4):183-92.

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