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Clinical manifestations of noncoronary atherosclerotic vascular disease after moderate dose irradiation
Version of Record online: 13 DEC 2005
Copyright © 2005 American Cancer Society
Volume 106, Issue 3, pages 718–725, 1 February 2006
How to Cite
Patel, D. A., Kochanski, J., Suen, A. W., Fajardo, L. F., Hancock, S. L. and Knox, S. J. (2006), Clinical manifestations of noncoronary atherosclerotic vascular disease after moderate dose irradiation. Cancer, 106: 718–725. doi: 10.1002/cncr.21636
- Issue online: 20 JAN 2006
- Version of Record online: 13 DEC 2005
- Manuscript Accepted: 30 AUG 2005
- Manuscript Revised: 8 JUL 2005
- Manuscript Received: 11 APR 2005
- noncoronary vascular disease;
- radiation injury;
Accelerated atherosclerosis and carotid stenosis are well-established risks occurring after high radiation doses that are used to treat cancers of the head and neck. Noncoronary vascular disease has been observed and may relate to more moderate dose irradiation.
A search of patients treated for Hodgkin disease, non-Hodgkin lymphoma, or seminoma was performed to identify cases with noncoronary vascular complications after irradiation. These three groups were chosen because of the use of intermediate dose radiation and prevalence of long-term survivors. Individual patient records were reviewed to document the type and presentation of the stenosis and the clinical factors that may have contributed to this risk.
Twenty-one patients were identified who developed disease in noncoronary arteries after treatment. The median time from irradiation to diagnosis of vascular stenosis was 15 years. Antecedent risk factors for vascular disease were prevalent. Five patients had disease identified by auscultation of bruits before an adverse clinical event occurred. Five patients died from complications related to their vascular disease, which included three deaths after stroke and two after small bowel infarction.
Twelve cases arose at an atypically young age for atherosclerotic vascular disease and featured unusual clinical presentations. Nine cases identified occurred at an advanced aged and at a shorter median interval, making a causal relation to irradiation uncertain. Incorporating careful auscultation for bruits in followup evaluation of irradiated patients may identify individuals who are at risk for adverse vascular events. The potential for early vasculopathy in individuals exposed to intermediate dose irradiation suggests a need to manage dyslipidemia and reduce vascular risk factors throughout the posttreatment period. Cancer 2006. © 2005 American Cancer Society.