title: Increased risk of stroke in young head and neck cancer patients treated with radiotherapy or chemotherapy.
abstract: BACKGROUND
  Chemo-radiotherapy-induced carotid stenosis and cerebrovascular events in head and neck cancer patients can cause severe disability and death. We aimed to estimate the risk of stroke in such patients over a six-year follow-up period.
  
  
  METHODS
  The study cohort consisted of head and neck cancer patients (n=10,172). Cox proportional hazard model was used to compare the stroke-free survival rate between the patients treated with radiotherapy or chemotherapy, surgery alone, and surgery with adjuvant therapy after adjusting for possible confounding factors.
  
  
  RESULTS
  At the end of follow-up, 384 patients had strokes: 126 (4.3%) from the surgery alone group, 167 (3.8%) from the radiotherapy or chemotherapy group, and 91 (3.2%) from the surgery with adjuvant therapy (P=0.222). Head and neck cancer patients aged less than 55 years treated with radiotherapy or chemotherapy conferred a 1.8-fold higher risk for stroke (95% CI, 1.22-2.56; P=0.003) after adjusting for patient characteristics, co-morbidities, geographic region, urbanization level, and socio-economic status. There was no statistical difference in stroke risk between different treatment modalities in head and neck cancer patients aged 55 years and more.
  
  
  CONCLUSIONS
  Young head and neck cancer patients treated with radiotherapy or chemotherapy have higher risks for stroke. Different treatment strategies should be considered in such patients.
authors.affiliation: Division of Neurology, Department of Internal Medicine, Buddhist Dalin Tzu Chi General Hospital, Chiayi, Taiwan.
authors.forename: Yung-Sung
authors.initials: YS
authors.lastname: Huang
authors.forename: Ching-Chieh
authors.initials: CC
authors.lastname: Lee
authors.forename: Ting-Shou
authors.initials: TS
authors.lastname: Chang
authors.forename: Hsu-Chueh
authors.initials: HC
authors.lastname: Ho
authors.forename: Yu-Chieh
authors.initials: YC
authors.lastname: Su
authors.forename: Shih-Kai
authors.initials: SK
authors.lastname: Hung
authors.forename: Moon-Sing
authors.initials: MS
authors.lastname: Lee
authors.forename: Pesus
authors.initials: P
authors.lastname: Chou
authors.forename: Yu-Han
authors.initials: YH
authors.lastname: Chang
authors.forename: Ching-Chih
authors.initials: CC
authors.lastname: Lee
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000970:Antineoplastic Agents / Q000009:adverse effects*; D017024:Chemotherapy, Adjuvant; D005260:Female; D005500:Follow-Up Studies; D006258:Head and Neck Neoplasms / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011832:Radiation Injuries / Q000453:epidemiology*; D018714:Radiotherapy, Adjuvant; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology* / Q000209:etiology; D013624:Taiwan / Q000453:epidemiology
chemical_list: D000970:Antineoplastic Agents