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Open Access Highly Accessed Research

Long-term effects on carotid intima-media thickness after radiotherapy in patients with nasopharyngeal carcinoma

Tai-Lin Huang12, Hsuan-Chih Hsu3, Hui-Chun Chen3, Hsin-Ching Lin4, Chih-Yen Chien4, Fu-Min Fang3, Chih-Cheng Huang5, Hsueh-Wen Chang6, Wen-Neng Chang5, Chi-Ren Huang5, Nai-Wen Tsai5, Chia-Te Kung7, Hung-Chen Wang8, Wei-Che Lin9, Ben-Chung Cheng106, Yu-Jih Su106, Ya-Ting Chang56, Chuang-Rung Chang2*, Teng-Yeow Tan5* and Cheng-Hsien Lu56*

Author Affiliations

1 Departments of Hematology-Oncology, Chang Gung University College of Medicine, Kaohsiung, Taiwan

2 Institute of Biotechnology and Department of Medical Science, National Tsing Hua University, Hsinchu, Taiwan

3 Departments of Radiation Oncology, Chang Gung University College of Medicine, Kaohsiung, Taiwan

4 Department of Otorhinolaryngology, Chang Gung University College of Medicine, Kaohsiung, Taiwan

5 Department of Neurology, Chang Gung University College of Medicine, Kaohsiung, Taiwan

6 Department of Biological Science, National Sun Yat-Sen University, Kaohsiung, Taiwan

7 Department of Emergency Medicine, National Sun Yat-Sen University, Kaohsiung, Taiwan

8 Department of Neurosurgery, National Sun Yat-Sen University, Kaohsiung, Taiwan

9 Department of Radiology, National Sun Yat-Sen University, Kaohsiung, Taiwan

10 Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan

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Radiation Oncology 2013, 8:261  doi:10.1186/1748-717X-8-261

Published: 7 November 2013

Abstract

Background

Vascular abnormalities are the predominant histologic changes associated with radiation in nasopharyngeal carcinoma (NPC). This study examined if the duration after radiotherapy correlates with the progression of carotid intima-media thickness (IMT) and investigated its relationship with inflammatory markers.

Methods

One hundred and five NPC patients post-radiotherapy for more than one year and 25 healthy control subjects were examined by B-mode ultrasound for IMT measurement at the far wall of the common carotid artery (CCA). Surrogate markers including lipid profile, HbA1c, and high sensitive C-reactive protein (hs-CRP) were assessed.

Results

The IMT of CCA was significantly increased in NPC patients and carotid plaque was detected in 38 NPC patients (38/105, 36.2%). Significant risk factors for carotid plaques included age, duration after radiotherapy, and HbA1c levels. Age, duration after radiotherapy, hs-CRP, HbA1c, and platelet count positively correlated with IMT. The cut-off value of age and duration after radiotherapy for the presence of plaque was 52.5 years and 42.5 months, respectively. In NPC subjects, multiple linear regression analysis revealed that age, gender, duration after radiotherapy and platelet counts were independently associated with CCA IMT. After adjustments for age, gender and platelet counts, IMT increased in a linear manner with duration after radiotherapy.

Conclusions

Radiation-induced vasculopathy is a dynamic and progressive process due to late radiation effects. Extra-cranial color-coded duplex sonography can be part of routine follow-up in NPC patients aged ≥50 years at 40 months post-radiotherapy.

Keywords:
Atherosclerosis; Nasopharyngeal carcinoma; Radiotherapy; Risk factors