Increased risk of ischemic stroke after radiotherapy on the neck in patients younger than 60 years
Increased risk of ischemic stroke after radiotherapy on the neck in patients younger than 60 years
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DOI：
10.1200/jco.20.1.282
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发表时间：
2002-01-01
影响因子：
45.3
通讯作者：
Bartelink, H
中科院分区：
文献类型：
--
作者：
Dorresteijn, LDA;Kappelle, AC;Bartelink, H
目的：评估头颈部肿瘤放疗患者发生缺血性脑卒中的风险。患者和方法：对年龄小于60岁的367例接受局部放疗（RT）的头颈部肿瘤患者（喉癌162例，多形性腺瘤114例，腮腺癌91例）进行缺血性脑卒中的发生率测定。缺血性脑卒中的相对危险度（RR）是通过与脑卒中发生率登记的人群进行比较来确定的，并根据性别和年龄进行了调整。卒中的其他危险因素（高血压、吸烟、高胆固醇血症、糖尿病[DM]）也被登记。RT后的中位随访时间为7.7年（3011人-年随访）。结果：发生了14例中风（预期，2.5；RR, 5.6； 95%可信区间[CI]， 3.1至9.4）：喉癌患者中有8例（预期，1.56；RR, 5.1; 95% CI， 2.2至10.1），多形性腺瘤患者中有4例（预期，0.71；RR, 5.7; 95% CI， 1.5至14.5），腮腺癌患者中有2例（预期，0.24；RR, 8.5, 95% CI， 1.0至30.6）。6例因腮腺肿瘤而接受放射治疗的患者中，有5例中风发生在同侧。脑血管疾病的其他危险因素分析显示高血压和糖尿病是导致RR升高的主要因素，随访10年以上，RR为10.1 （95% C1, 4.4 ~ 20.0）。颈部放疗后15年累积卒中风险为12.0% （95% CI, 6.5% - 21.4%）。结论：这是第一个证明颈部放射治疗后卒中风险增加的研究。在医学随访中，应采取预防措施，减少脑血管疾病危险因素的影响，减少这些患者发生脑卒中。
Purpose: To estimate the risk of ischemic stroke in patients irradiated for head and neck tumors.Patients and Methods: The incidence of ischemic stroke was determined in 367 patients with head and neck tumors (162 larynx carcinomas, 114 pleomorphic adenomas, and 91 parotid carcinomas) who had been treated with local radiotherapy (RT) at an age younger than 60 years. Relative risk (RR) of ischemic stroke was determined by comparison with population rates from a stroke-incidence register, adjusted for sex and age. Other risk factors for stroke (hypertension, smoking, hypercholesterolemia, diabetes mellitus [DM]) were registered. The median follow-up time after RT was 7.7 years (3,011 person-years of follow-up).Results: Fourteen cases of stroke occurred (expected, 2.5; RR, 5.6; 95% confidence interval [CI], 3.1 to 9.4): eight in patients with laryngeal carcinoma (expected,1.56; RR, 5.1; 95% CI, 2.2 to 10.1), four in pleomorphic adenoma patients (expected, 0.71; RR, 5.7; 95% CI, 1.5 to 14.5), and two in parotid carcinoma patients (expected, 0.24; RR, 8.5, 95% CI, 1.0 to 30.6). Five of six strokes in patients irradiated for a parotid tumor occurred at the ipsilateral side. Analysis of other risk factors for cerebrovascular disease showed hypertension and DM to cause an increase of the RR after RT. After more than 10 years' follow-up, the RR was 10.1 (95% C1, 4.4 to 20.0). The 15-year cumulative risk of stroke after RT on the neck was 12.0% (95% CI, 6.5% to 21.4%).Conclusion: This is the first study to demonstrate an increased risk of stroke after RT on the neck. During medical follow-up, preventive measures should be taken to reduce the impact of the risk factors for cerebrovascular disease, to decrease stroke in these patients.