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Long-term effects of neck irradiation on cardiovascular autonomic function: A study in nasopharyngeal carcinoma patients after radiotherapy

Authors

  • Chih-Cheng Huang MD, PhD,

    1. Department of Neurology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
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  • Tai-Lin Huang MD,

    1. Department of Hematology–Oncology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
    2. Institute of Biotechnology and Department of Medical Science, National Tsing Hua University, Hsinchu, Taiwan
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  • Hsuan-Chih Hsu MD,

    1. Department of Radiation Oncology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
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  • Hui-Chun Chen MD,

    1. Department of Radiation Oncology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
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  • Hsin-Ching Lin MD,

    1. Department of Otorhinolaryngology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
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  • Chih-Yen Chien MD,

    1. Department of Otorhinolaryngology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
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  • Fu-Min Fang MD, PhD,

    1. Department of Radiation Oncology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
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  • Hsueh-Wen Chang PhD,

    1. Department of Biological Science, National Sun Yat-Sen University, Kaohsiung, Taiwan
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  • Nai-Wen Tsai MD, PhD,

    1. Department of Neurology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
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  • Wen-Neng Chang MD,

    1. Department of Neurology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
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  • Shu-Fang Chen MD,

    1. Department of Neurology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
    2. Department of Biological Science, National Sun Yat-Sen University, Kaohsiung, Taiwan
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  • Tzu-Kong Lin MD, PhD,

    1. Department of Neurology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
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  • Teng-Yeow Tan MD,

    1. Department of Neurology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
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  • Chuang-Rung Chang PhD,

    1. Institute of Biotechnology and Department of Medical Science, National Tsing Hua University, Hsinchu, Taiwan
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  • Hung-Chen Wang MD,

    1. Department of Neurosurgery Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
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  • Wei-Che Lin MD, PhD,

    1. Department of Radiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
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  • Cheng-Hsien Lu MD, MSc

    Corresponding author
    1. Department of Biological Science, National Sun Yat-Sen University, Kaohsiung, Taiwan
    • Department of Neurology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
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Department of Neurology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, 123 Ta Pei Road, Niao Sung District, Kaohsiung, Taiwan. E-mail: chlu99@ms44.url.com.tw

Abstract

Introduction

Baroreflex failure has been reported as a late sequalum of neck radiotherapy. In this study we investigated cardiovascular autonomic function in patients after neck radiotherapy to determine predictive factors associated with outcome.

Methods

Eighty-nine patients with nasopharyngeal carcinoma were evaluated ≥6 months after radiotherapy for cardiovascular autonomic function and compared with 48 control subjects. Inflammatory markers and carotid intima–media thickness were also assessed.

Results

Autonomic parameters of heart rate response to deep breathing and Valsalva ratio were significantly lower in the patient group. Cardiovascular autonomic impairment was generally mild with relative sparing of the efferent cardiovagal pathway. By univariate and multivariate analyses, the time after radiotherapy and C-reactive protein level were significantly associated with the degree of cardiovascular autonomic dysfunction.

Conclusions

Radiation-induced cardiovascular autonomic impairment is a dynamic and progressive process that occurs long after radiotherapy. Chronic inflammation plays a major role in this process. Muscle Nerve 47:344-350, 2013

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