title: Risk of fatal cerebrovascular accidents after external beam radiation therapy for early-stage glottic laryngeal cancer.
abstract: BACKGROUND
  This study compared the risk of fatal cerebrovascular accidents (CVAs) in patients with early-stage glottic laryngeal cancer receiving surgery or external beam radiation therapy (EBRT).
  
  
  METHODS
  Using a competing risks survival analysis, we compared the risk of death because of CVA among patients with early-stage glottic laryngeal cancer receiving surgery or EBRT in the Surveillance, Epidemiology, and End Results (SEER) database.
  
  
  RESULTS
  The cumulative incidence of fatal CVA at 15 years was higher in patients receiving EBRT (2.8%; 95% confidence interval [CI], 2.3% to 3.4%) compared to surgery (1.5%; 95% CI, 0.8% to 2.3%; p = .024). In multivariable competing risks regression models, EBRT remained associated with an increased risk of fatal CVA compared to surgery (adjusted hazard ratio [HR], 1.75; 95% CI, 1.04-2.96; p = .037).
  
  
  CONCLUSIONS
  Treatment for early-stage glottic laryngeal cancer with EBRT was associated with a small increase in the risk of late fatal CVA events relative to surgery.
authors.affiliation: Department of Radiation Oncology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Samuel
authors.initials: S
authors.lastname: Swisher-McClure
authors.forename: Nandita
authors.initials: N
authors.lastname: Mitra
authors.forename: Alexander
authors.initials: A
authors.lastname: Lin
authors.forename: Peter
authors.initials: P
authors.lastname: Ahn
authors.forename: Fei
authors.initials: F
authors.lastname: Wan
authors.forename: Bert
authors.initials: B
authors.lastname: O'Malley
authors.forename: Gregory S
authors.initials: GS
authors.lastname: Weinstein
authors.forename: Justin E
authors.initials: JE
authors.lastname: Bekelman
mesh_terms: D000368:Aged; D002423:Cause of Death; D016001:Confidence Intervals; D018572:Disease-Free Survival; D055088:Early Detection of Cancer; D005260:Female; D005500:Follow-Up Studies; D005931:Glottis / Q000473:pathology; D006801:Humans; D007822:Laryngeal Neoplasms / Q000401:mortality* / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D007825:Laryngectomy / Q000009:adverse effects* / Q000379:methods; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009361:Neoplasm Invasiveness / Q000473:pathology; D009367:Neoplasm Staging; D016016:Proportional Hazards Models; D011882:Radiotherapy, High-Energy / Q000009:adverse effects* / Q000379:methods; D012042:Registries; D012044:Regression Analysis; D012189:Retrospective Studies; D018570:Risk Assessment; D018426:SEER Program; D020521:Stroke / Q000209:etiology* / Q000401:mortality* / Q000503:physiopathology; D015996:Survival Rate; D016896:Treatment Outcome
keywords: cerebrovascular accidents; laryngeal cancer; radiation therapy