title: Risk of cerebrovascular events in elderly patients after radiation therapy versus surgery for early-stage glottic cancer.
abstract: OBJECTIVE
  Comprehensive neck radiation therapy (RT) has been shown to increase cerebrovascular disease (CVD) risk in advanced-stage head-and-neck cancer. We assessed whether more limited neck RT used for early-stage (T1-T2 N0) glottic cancer is associated with increased CVD risk, using the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database.
  
  
  METHODS
  We identified patients ≥66 years of age with early-stage glottic laryngeal cancer from SEER diagnosed from 1992 to 2007. Patients treated with combined surgery and RT were excluded. Medicare CPT codes for carotid interventions, Medicare ICD-9 codes for cerebrovascular events, and SEER data for stroke as the cause of death were collected. Similarly, Medicare CPT and ICD-9 codes for peripheral vascular disease (PVD) were assessed to serve as an internal control between treatment groups.
  
  
  RESULTS
  A total of 1413 assessable patients (RT, n=1055; surgery, n=358) were analyzed. The actuarial 10-year risk of CVD was 56.5% (95% confidence interval 51.5%-61.5%) for the RT cohort versus 48.7% (41.1%-56.3%) in the surgery cohort (P=.27). The actuarial 10-year risk of PVD did not differ between the RT (52.7% [48.1%-57.3%]) and surgery cohorts (52.6% [45.2%-60.0%]) (P=.89). Univariate analysis showed an increased association of CVD with more recent diagnosis (P=.001) and increasing age (P=.001). On multivariate Cox analysis, increasing age (P<.001) and recent diagnosis (P=.002) remained significantly associated with a higher CVD risk, whereas the association of RT and CVD remained not statistically significant (HR=1.11 [0.91-1.37,] P=.31).
  
  
  CONCLUSIONS
  Elderly patients with early-stage laryngeal cancer have a high burden of cerebrovascular events after surgical management or RT. RT and surgery are associated with comparable risk for subsequent CVD development after treatment in elderly patients.
authors.affiliation: Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin 53792, USA.
authors.forename: Julian C
authors.initials: JC
authors.lastname: Hong
authors.forename: Tim J
authors.initials: TJ
authors.lastname: Kruser
authors.forename: Vinai
authors.initials: V
authors.lastname: Gondi
authors.forename: Pranshu
authors.initials: P
authors.lastname: Mohindra
authors.forename: Donald M
authors.initials: DM
authors.lastname: Cannon
authors.forename: Paul M
authors.initials: PM
authors.lastname: Harari
authors.forename: Søren M
authors.initials: SM
authors.lastname: Bentzen
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery; D002423:Cause of Death; D002561:Cerebrovascular Disorders / Q000209:etiology* / Q000401:mortality; D005260:Female; D005931:Glottis; D006801:Humans; D007822:Laryngeal Neoplasms / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D008297:Male; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality; D012306:Risk; D018426:SEER Program; D020521:Stroke / Q000209:etiology / Q000401:mortality