Key result
Neck radiotherapy linked to ~30% long-term risk of significant carotid stenosis.
Why the study?
Despite an increased risk of carotid artery stenosis and cerebrovascular disease after radiotherapy for head and neck cancers, universal screening and treatment are not standardized across international guidelines.
Neck radiotherapy causes accelerated radiation-induced carotid stenosis, underscoring the need for routine surveillance (e.g., carotid ultrasound) and aggressive cardiovascular risk management in head and neck cancer survivors.
Patients undergoing radiotherapy (RT) for head and neck cancers (HNCs) face a significantly increased risk of developing carotid artery stenosis (CAS) and cerebrovascular disease (CVD). This condition, known as accelerated or radiation-induced carotid atherosclerosis, represents a long-term toxicity that profoundly impacts patients’ quality of life and survival. Pathogenesis is complex, involving mechanisms such as direct endothelial damage, oxidative stress, chronic inflammatory activation, peri-adventitial fibrosis, and the acceleration of pre-existing atherosclerotic processes. Despite this elevated risk, universal screening and treatment are not yet standardized across all international guidelines. This narrative review summarizes the epidemiology, pathological mechanisms, and clinical implications of accelerated radiation-induced carotid stenosis (RICS) after neck irradiation.
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Mauriello et al. (2026) conducted a review in Radiation-induced carotid artery disease in Head and Neck Cancer. Neck radiotherapy vs. No neck radiotherapy was evaluated. Neck radiotherapy for head and neck cancers significantly increases the risk of developing accelerated carotid atherosclerosis and ischemic cerebrovascular events, with >50% stenosis rates reaching 25-30% long-term.
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