The Effect of Head and Neck Radiotherapy on Blood Pressure and Orthostatic Hypotension in Patients With Head and Neck Tumors
The Effect of Head and Neck Radiotherapy on Blood Pressure and Orthostatic Hypotension in Patients With Head and Neck Tumors
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DOI：
10.1093/ajh/hpx158
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发表时间：
2018-02-01
影响因子：
3.2
通讯作者：
Gluck, Iris
中科院分区：
文献类型：
--
作者：
Leibowitz, Avshalom;Grossman, Ehud;Gluck, Iris
放射治疗（RT）在头颈癌（HNC）的治疗中起着关键作用，特别是在局部晚期疾病中。头颈部放射治疗的患者，尤其是老年患者，在治疗过程中会出现低血压和不稳定的血压。他们抱怨虚弱和疲劳，并容易反复福尔斯。本研究的目的是描述RT period. METHODS患者的血压变化与HNC，接受放射治疗的颈部，从沙巴医学中心RT单位招募。在治疗开始后30天和90天的基线测量诊室血压、体位测量、24小时动态血压监测、体重和代谢参数。9名高血压患者在研究期间继续接受抗高血压治疗。诊室收缩压和舒张压在30天后显著降低（128 +/- 4/80 +/- 3至122 +/- 3/74 +/- 3 mm Hg; P < 0.05）。RT 30天后的平均24小时BP值从130 +/- 3/76 +/- 2降至123 +/- 3/71 +/- 2 mmHg; P < 0.05。观察到白天和夜间BP水平的类似趋势。RT完成后，办公室和门诊血压持续下降数月。研究期间未观察到体位性。患者在研究期间体重明显减轻。然而，BP的变化是独立的体重loss. CONCLUSION有一个显着的和持续的血压降低后，头部和颈部RT，没有直立性的变化。临床医生应该意识到这种现象，并考虑相应的治疗适应。
BACKGROUNDRadiotherapy (RT) plays a key role in the management of head and neck cancer (HNC), especially in locally advanced disease. Patients undergoing head and neck RT, especially elderly ones, are suffering from low and labile blood pressure (BP) during the treatment. They complain of weakness and fatigue and are prone to recurrent falls. The aim of this study was to characterize BP changes during RT period.METHODSPatients with HNC, receiving radiation to the neck, were recruited from Sheba medical center RT unit. Office BP, orthostatic measurements, 24-hour ambulatory BP monitoring, body weight, and metabolic parameters were measured at baseline after 30 days and after 90 days from beginning of therapy.RESULTSNineteen patients (17 males), 64 +/- 12 years old were recruited. Nine hypertensive patients continued their antihypertensive treatment during the study. Office systolic BP and diastolic BP decreased significantly after 30 days (128 +/- 4/80 +/- 3 to 122 +/- 3/74 +/- 3 mm Hg; P < 0.05). Average 24-hour BP values after 30 days of RT decreased from 130 +/- 3/76 +/- 2 to 123 +/- 3/71 +/- 2 mm Hg; P < 0.05. A similar trend was observed for day and night BP levels. Decrease in office and ambulatory BP was sustained for several months after RT completion. No orthostasis was observed during the study period. Patient lost weight significantly during the study period. However, BP changes were independent of weight loss.CONCLUSIONThere is a significant and sustained BP reduction after head and neck RT, without orthostatic changes. Clinicians should be aware of this phenomenon and consider treatment adaption accordingly.