Key result
Radiotherapy alone is linked to ~226% greater ischemic stroke risk versus surgery in cervical cancer.
Why the study?
Limited sample size and short-term follow-up have impaired previous analyses evaluating the impact of different cancer treatment modalities on the risk of ischemic stroke in cervical cancer.
Do different treatment modalities (chemotherapy, radiotherapy, or combinations) increase the risk of ischemic stroke compared to surgery alone in cervical cancer patients?
Do different treatment modalities (chemotherapy, radiotherapy, or combinations) increase the risk of ischemic stroke compared to surgery alone in cervical cancer patients?
Radiotherapy alone is associated with a more than three-fold increased risk of ischemic stroke compared to surgery alone in cervical cancer patients, particularly in those older than 55 years.
May warrant stroke surveillance after RT in cervical cancer patients >55; leaves open causality and preventive strategies pending prospective validation.
Chemotherapy, radiotherapy, and surgery have been reported to affect the incidence of ischemic stroke in cervical cancer. However, limited sample size and short-term follow up impair the power of analysis. This study aimed to evaluate the impact of different treatment modalities on risk of ischemic stroke (IS) with national population and long-term follow up. We conducted a nationwide population-based, retrospective cohort study using claims data from Taiwan's National Health Insurance program between 2008 and 2014. Cervical cancer patients aged 20 years or more who underwent surgery alone with oophorectomy (n = 1895) were compared with those who received surgery plus chemotherapy (SCT) (n = 1049), concurrent chemotherapy plus radiotherapy (CCRT) (n = 2631), chemotherapy (C/T) alone (n = 1778), and radiotherapy (RT) alone (n = 580). The follow-up period ranged from 5 to 11 years. The multivariate Cox proportional hazards regression models, Kaplan–Meier product-limit method, and the Gray k-sample test were used to assess the risk of IS. During a median follow-up period of 9.1 years, a total of 258 cases (3.3 %) developed IS with the shortest median time-to-event of 1 year in the RT group. The development of IS had negative impact on patients older than 55 years old (hazard ratio, 2.71; 95 % confidence level, 1.96–3.74). In comparison to surgery alone, the hazard risk of IS risk were 1.92, 1.58, and 3.26 for C/T, CCRT, and RT alone, respectively. When stratified by age older than 55 years, older patients who received RT alone had higher risk in terms of treatment modalities. For comorbidity sub-analysis, the older patients had higher risk of IS particularly in those bearing more than two stroke-related risk factors (6.3 % in <55 y/o versus 16.7 % in >55 y/o). For cervical cancer patients older than 55 years old and/or bearing comorbidities related to IS, the RT alone remains reasonable option and the risk of IS should be cautioned.
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Wang et al. (2026) studied this question. Radiotherapy alone increased the risk of ischemic stroke by 3.26 times in cervical cancer patients compared to surgery alone, particularly in those over 55 years old.
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