Carotid Stenosis After Radiotherapy for Nasopharyngeal Carcinoma

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Abstract
RADIATION injury to the carotid arteries, with resultant stenosis and stroke, is a well-known long-term sequela of cervical radiotherapy (RT). Despite the widespread use of irradiation of the head and neck, the incidence and pattern of radiation-induced carotid stenosis in patients who have undergone cervical RT have rarely been studied and have remained largely unknown. Carotid endarterectomy in an irradiated field is often hampered by adhesions and the often extensive distribution of disease (Figure 1). The introduction of carotid angioplasty and stenting as an alternative treatment of these difficult lesions has generated a renewed interest in RT-induced carotid stenosis. Nasopharyngeal carcinoma (NPC) is a common type of malignant neoplasm among Chinese patients in Hong Kong, with an annual incidence of 18.7 per 100 000 population.1 External irradiation is the treatment of choice for early NPC, as well as an adjuvant treatment of local and cervical lymph node recurrences. With improved surgical treatment, such as nasopharyngectomy, and aggressive adjuvant RT, more patients now enjoy a longer survival. Carotid stenosis poses a threat of stroke to these patients and should be borne in the minds of surgeons and radiation oncologists. This study aimed to determine the prevalence, pattern, and risk factors for radiation-induced carotid stenosis in a group of patients with NPC, using color-flow duplex scanning.

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