Key result
Radiotherapy for nasopharyngeal carcinoma linked to ~4-fold greater annual carotid IMT increase vs healthy controls.
Why the study?
Radiation-related extracranial vasculopathy is a common late effect after radiation in nasopharyngeal carcinoma, but whether it begins immediately after radiotherapy and persists long term via inflammation and oxidative stress was unclear.
Does concurrent chemoradiation therapy accelerate the progression of carotid atherosclerosis (measured by CCA IMT) in patients with nasopharyngeal carcinoma compared to healthy controls?
Cohort (n=36)
Does concurrent chemoradiation therapy accelerate the progression of carotid atherosclerosis (measured by CCA IMT) in patients with nasopharyngeal carcinoma compared to healthy controls?
Absolute Event Rate: 0.053% vs 0.014%
p-value: p=<0.0001
Radiotherapy for nasopharyngeal carcinoma is associated with a significantly accelerated progression of carotid intima-media thickness over 9 years, potentially driven by chronic inflammation and oxidative stress.
May warrant carotid surveillance in NPC radiotherapy recipients; hypothesis-generating and requires prospective validation.
Radiation-related extracranial vasculopathy is a common late effect after radiation in patients with nasopharyngeal carcinoma (NPC). We proposed the hypothesis that radiation-related extracranial vasculopathy is a progressive process that can begin immediately after radiotherapy and persist for a longer period, and inflammation and oxidative stress may play a pivotal role in this process. Thirty-six newly diagnosed NPC patients were assessed with B-mode ultrasound for the common carotid artery (CCA) intima media thickness (IMT) measurement as well as surrogate markers at three different stages (baseline, immediately after concurrent chemoradiation therapy (CCRT), and 9 years after enrollment). A healthy control group was also recruited for comparison. Surrogate markers including a lipid profile, HbA1c, inflammation, oxidative stress, and platelet activation markers were assessed. The mean CCA IMT in the NPC group were increased immediately after CCRT (p = 0.043). The mean CCA IMT value after a 9-year follow-up also showed a significant increase in NPC and control group, respectively (p < 0.0001 and p < 0.0001, paired t test). The annual increase mean CCA IMT (mm) was 0.053 ± 0.025 and 0.014 ± 0.013 in NPC and control group, respectively (p < 0.0001). The baseline high sensitivity CRP (hs-CRP), thiol, TBARS, and CD63 level were significantly higher in the NPC group (hs-CRP, p = 0.001, thiol, p < 0.0001, TBARS, p = 0.05, and CD63 level, p = 0.04). The thiol and TBARS levels were significantly lower in NPC patients immediately after CCRT (thiol, p < 0.0001, and TBARS, p = 0.043). The CD62P level was significantly higher while the thiol level was significantly lower in the NPC group after a 9-year follow-up (CD62P level, p = 0.007; and thiol level, p = 0.004). Radiation-related extracranial vasculopathy is a progressive process that begins immediately after radiotherapy with significantly increased carotid IMT compared to the control group during the 9-year follow-up. Chronic inflammation and oxidative stress might serve to drive the process and also contribute to increased platelet activation.
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Lu et al. (2022) conducted a cohort in Nasopharyngeal carcinoma (n=36). Radiotherapy / Concurrent chemoradiation therapy (CCRT) vs. Healthy control group was evaluated on Annual increase in mean common carotid artery (CCA) intima media thickness (IMT) (mm) (p=<0.0001). Radiotherapy in nasopharyngeal carcinoma patients was associated with a greater annual increase in mean carotid intima media thickness compared to healthy controls (0.053 vs 0.014 mm; p<0.0001).
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