Key result
Head and neck radiotherapy linked to ~28% screening-detected carotid stenosis, escalating beyond five years.
Why the study?
Long-term vascular toxicity after radiotherapy for head and neck cancer is a clinically important yet underrecognized late effect.
What is the incidence of arterial and venous vascular complications after radiotherapy for head and neck cancer?
Meta-Analysis (n=2,682)
What is the incidence of arterial and venous vascular complications after radiotherapy for head and neck cancer?
Vascular complications are a substantial late effect of head and neck radiotherapy, with screening-detected carotid stenosis being three times more prevalent than clinical stroke/TIA, and risk escalating markedly beyond 5 years.
Answers are grounded in this paper and cite their sources.
May support enhanced vascular surveillance in head and neck cancer survivors post-radiotherapy; leaves open optimal screening protocols pending prospective trials.
e18104 Background: Advances in radiotherapy (RT) have improved locoregional control and survival in head and neck cancer (HNC). Long-term vascular toxicity is a clinically important yet underrecognized late effect. This is the first meta-analysis to systematically quantify the incidence of radiation-associated vascular toxicity using only primary studies, stratified by mode of detection and duration of follow-up. Methods: We searched MEDLINE, Embase, and Cochrane (inception-Jan 2025) databases. A meta-analysis of proportions using random-effects models was performed, stratified by detection method (screening vs. clinical) and follow-up (≤5 years, >5 years). Only primary observational studies were included in the quantitative synthesis. Results: A meta-analysis of 12 observational studies (n=2,682) was performed using a random-effects model. The pooled incidence of screening-detected carotid stenosis (≥50%) was 28.3% (95% CI: 21.5–35.7), significantly higher than the 9.4% (95% CI: 6.2–13.3) incidence of clinically-detected stroke/TIA—a 3.0-fold difference. Subgroup analysis revealed a strong time-dependent relationship: incidence was 7.5% within 5 years post-RT but escalated to 32.1% beyond 5 years. Venous complications (jugular thrombosis/stenosis) were sparsely reported (2-5% incidence in 2 studies). Statistical heterogeneity was high across all analyses (I² > 80%). Meta-analysis revealed a 28.3% incidence of screening-detected carotid stenosis (≥50%) versus 9.4% for clinical stroke/TIA—a 3.0-fold disparity. Incidence rose progressively from 7.5% (<5 years) to 32.1% (>5 years) post-RT. Conclusions: Based on primary data, vascular complications represent a substantial under-recognized survivorship burden. Screening-detected disease is three times more prevalent than clinically apparent disease. The marked escalation in risk beyond 5 years post-RT justifies consideration of targeted surveillance for high-risk, long-term survivors.
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Vincent et al. (2026) conducted a meta-analysis in Head and neck cancer (n=2,682). Radiotherapy was evaluated on Incidence of screening-detected carotid stenosis (≥50%) vs clinically-detected stroke/TIA (3.0-fold difference, 95% CI 21.5-35.7 vs 6.2-13.3). Radiotherapy for head and neck cancer resulted in a 28.3% incidence of screening-detected carotid stenosis (≥50%) versus 9.4% for clinical stroke/TIA, with risk escalating beyond 5 years.
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