Initial surgery may be associated with lower stroke risk for patients with head and neck cancer

PHILADELPHIA – Radiotherapy and chemotherapy for head and neck cancer may be associated with a significantly increased risk of stroke compared to initial surgery, suggests a new study by researchers from the Perelman School of Medicine to University of Pennsylvania.

The researchers analyzed the medical records of more than 10,000 US veterans who were diagnosed with non-metastatic oropharynx. squamous cell carcinoma (OPSCC) over the period 2000-2020. They found that patients in this cohort who had initial surgery, rather than radiation therapy or chemotherapy with radiation therapy, had a 23% lower risk of stroke over the next 10 years.

The results will be presented (Abstract #6057) at the 2022 Annual Meeting of the American Society of Clinical Oncology (ASCO) to be held June 3-7, 2022 in Chicago.

“We should consider taking this difference in stroke risk into account in patient counseling and treatment decisions, and conducting further studies of cardiovascular events in this high-risk population,” the author said. major. Lova L. Sun MD, MSCE, Assistant Professor of Hematology-Oncology. “There is a significant subset of patients with squamous cell carcinoma of the oropharynx for whom it is reasonable to offer surgery or radiation therapy in advance, and for these patients the potential increased risk of stroke should be an additional risk-benefit factor.”

Each year, more than 50,000 people in the United States are diagnosed with oropharyngeal cancers, and more than 10,000 die from it. Standard treatment includes either surgery or radiation therapy and chemotherapy. However, in recent years researchers have begun to find evidence that radiation and chemotherapy for these cancers can increase the risk of stroke, potentially by damaging the arteries that serve the brain.

Sun and his colleagues in their study added to this evidence base by analyzing the records of a cohort of US veterans – a total of 10,436 people who were diagnosed with non-metastatic OPSCC. These people, around 99% of whom were men, were treated either by radiotherapy with or without chemotherapy and without surgery (7,719 people), or by initial surgery with or without chemotherapy and radiotherapy (2,717 people).

The results showed that 12.5% ​​of the total group, or one in eight, suffered a stroke during the follow-up period of up to 10 years after treatment, making this overall a high-risk group. By comparison, the average 65-year-old American male would face a 10-year risk of stroke of about 7%.

The analysis also found that patients who underwent surgery had a 23% lower risk of stroke, after accounting for differences between patients who underwent surgery and non-surgical treatment with methods of propensity score weightings, which estimate the likelihood of obtaining a treatment and help isolate the effect of a treatment from other differences that may exist between the treatment and comparison groups.

These patients had, on average, shorter radiation and chemotherapy cycles compared to the non-surgery group, suggesting that reduced exposure to these sources of tissue damage may have been a factor in reducing stroke risk. . Moreover, the link between surgery and a lower risk of stroke was observed in different age groups, and in groups with and without hypertension, high cholesterol and diabetes, implying that differences in these other risk factors cannot fully explain the lower stroke rate in the surgery group. .

Sun and his colleagues suggest that more research be done to further clarify the effect of radiation therapy and chemotherapy on the risk of stroke and other cardiovascular events, but in the meantime physicians and patients should consider the possibility of a lower stroke risk with initial surgery when considering options for OPSCC treatment.

This work was supported by a pilot faculty grant from Penn’s Department of Otorhinolaryngology.

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