carotid stenosis – Oral Cancer News

Evaluation of Carotid Angioplasty and Stenting for Radiation-Induced Carotid Stenosis

Authors: Simon C.H. Yu, MD; Winnie X.Y. Zou, PhD; Yannie O.Y. Soo, MD;Lily Wang, MD; Joyce Wai Yi Hui, FRCR; Anne Y.Y. Chan, MD; Kwok Tung Lee, MSc; Vincent H.L. Ip, MD; Florence S.Y. Fan, MD; Annie L.C. Chan, MSc; Lawrence K.S. Wong, MD; Thomas W. Leung, MDSource: http://stroke.ahajournals.org Abstract Background and Purpose—We aimed to evaluate the procedural safety, clinical, and angiographic outcome of carotid angioplasty and stenting for high-grade (≥70%) radiation-induced carotid stenosis (RIS) using atherosclerotic stenosis (AS) as a control. Methods—In this 6-year prospective nonrandomized study, we compared the carotid angioplasty and stenting outcome of 65 consecutive patients (84 vessels) with RIS with that of a control group of 129 consecutive patients (150 vessels) with AS. Study end points were 30-day periprocedural stroke or death, ipsilateral ischemic stroke, technical success, procedural characteristics, instent restenosis (ISR; ≥50%) and symptomatic ISR. Results—The median follow-up was 47.3 months (95% confidence interval, 26.9–61.6). Imaging assessment was available in 74 vessels (RIS) and 120 vessels (AS) in 2 years. Comparing RIS group with AS group, the rates of periprocedural stroke or death were 1.5% (1/65) versus 1.6% (2/129; P=1); ipsilateral ischemic stroke rates were 4.6% (3/65) versus 4.7% (6/129; P=1); the annual risks of ipsilateral ischemic stroke were 1.2% (3 patient/254.7 patient year) versus 1.2% (6 patient/494.2 patient year; P=0.89); technical success rates were both 100%. Stenting of common carotid artery and the use of multiple stents was more common in the RIS group (P=0 in both cases); ISR rates were 25.7% (19/74) versus 4.2% (5/120; P<0.001); symptomatic ISR rates were 6.8% (5/74) versus 0.8% (1/120; P=0.031). [...]

Charlotte Parker2014-04-30T11:02:35-07:00April, 2014|Oral Cancer News|

New Guidelines for Reirradiation of Head and Neck Cancer

Source: Medscape News Today When head and neck cancer recurs and surgery is not an option, reirradiation provides the only potentially curative option. However, because the tumor often recurs in the same place or very close to tissue that has already been irradiated, this treatment approach represents a "significant challenge." For this reason, it should be handled at a tertiary-care center, according to a new guideline issued by the American College of Radiology. Specifically, it stipulates that the tertiary center should have a head and neck oncology team that is equipped with the resources and the experience to manage the complexities and toxicities of retreatment. In the guideline, published in the International Journal of Radiation Oncology, Biology and Physics, a panel of experts outline appropriateness criteria for various clinical scenarios that arise with such patients. It provides a consensus on how patients should be managed. "This is an important document because it is the first set of guidelines for the potentially curative treatment of patients who have regrowth of head and neck tumors. It provides a consensus on how patients should be managed," coauthor Madhur Kumar Garg, MD, said in a statement. Dr. Garg is from the Department of Radiation Oncology at Montefiore Medical Center, in the Bronx, New York, where about a dozen reirradiation procedures are performed annually. Commitment to Retreatment Retreatment is justified because clinical trial results have shown that local treatment improves overall survival, the panel of experts notes. However, they emphasize that, before a commitment to [...]

Oral Cancer Foundation News Team - A2011-10-18T10:35:08-07:00October, 2011|Oral Cancer News|

Stroke and TIA risk doubled by radiotherapy, study finds

Source: www.imt.ie Author: Mary Anne Kenny The risk of transient ischaemic attack (TIA) or ischaemic stroke is at least doubled by head and neck radiotherapy, a problem increasing in urgency as patients survive their malignancies longer, an Australian review of the literature has concluded. Besides case reports, the reviewers found 77 studies of stroke, TIA or rates of carotid stenosis in patients who had received radiation therapy for primary or secondary cancers of the head or neck region. The 17 epidemiological studies revealed that the procedures appear to “at least double” the relative risk of TIA or stroke, with the exception of adjuvant neck radiotherapy for breast cancer where no association was found. Radiotherapy for breast cancer resulted in only the carotid artery only being minimally exposed to radiation, the authors reported in Stroke. The evidence for radiation vasculopathy (defined as chronic occlusive cerbrovascular disease affecting medium- and large-diameter arteries) was strongest where the exposure occurred in childhood, but the exact magnitude of the increase was unclear due to heterogeneity in the studies. Considering the 17 imaging studies, the reviewers found they repeatedly showed “an increased prevalence of haemodynamically significant carotid stenosis” when there was a history of head and neck radiotherapy. The most significant radiologic evidence implicating radiotherapy in TIA and stroke was the spatial distribution of the vascular disease itself, they said. “It signposts the [radiotherapy] field.” Two theories of the pathogenesis of radiation vasculopathy were presented in the literature, they said. One was that it was an [...]

Oral Cancer Foundation News Team - A2011-08-11T07:21:03-07:00August, 2011|Oral Cancer News|