Premature carotid artery disease in pediatric cancer survivors treated with neck irradiation

Authors

  • Kathleen A. Meeske PhD,

    Corresponding author
    1. Department of Pediatrics, Keck School of Medicine of the University of Southern California, Los Angeles, California
    2. Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, California
    3. Division of Hematology-Oncology, Childrens Hospital Los Angeles, Los Angeles, California
    • Division of Hematology-Oncology, Childrens Hospital Los Angeles, 4650 Sunset Blvd. MS #54, Los Angeles, CA 90027.
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  • Stuart E. Siegel MD,

    1. Department of Pediatrics, Keck School of Medicine of the University of Southern California, Los Angeles, California
    2. Division of Hematology-Oncology, Childrens Hospital Los Angeles, Los Angeles, California
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  • Vicente Gilsanz MD,

    1. Department of Pediatrics, Keck School of Medicine of the University of Southern California, Los Angeles, California
    2. Division of Radiology, Childrens Hospital Los Angeles, Los Angeles, California
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  • Leslie Bernstein PhD,

    1. Department of Population Sciences, City of Hope, Duarte, California
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  • Mary B. Nelson MS,

    1. Division of Radiology, Childrens Hospital Los Angeles, Los Angeles, California
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  • Richard Sposto PhD,

    1. Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, California
    2. Division of Hematology-Oncology, Childrens Hospital Los Angeles, Los Angeles, California
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  • Fred A. Weaver MD,

    1. Department of Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California
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  • Robert S. Lavey MD,

    1. Department of Radiation Oncology, University of Southern Florida, Gainesville, Florida
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  • M.P.H. Wendy J. Mack PhD,

    1. Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, California
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  • Marvin D. Nelson Jr. MD, MBA

    1. Department of Pediatrics, Keck School of Medicine of the University of Southern California, Los Angeles, California
    2. Division of Radiology, Childrens Hospital Los Angeles, Los Angeles, California
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Abstract

Background

While carotid artery disease and strokes have been documented in adult cancer patients treated with neck irradiation, little information is available on pediatric patients. The purpose of this study is to determine if carotid disease is more prevalent among pediatric cancer survivors treated with neck irradiation than among healthy controls.

Procedure

Thirty pediatric cancer survivors who received neck irradiation (2,000–6,660 cGy) and 30 healthy subjects underwent bilateral carotid ultrasounds. Study outcome measures were common carotid intima-media thickness (IMT) and plaque (present or absent). Multivariate methods were used to compare cases and controls and to identify risk factors related to carotid disease in childhood cancer survivors.

Results

IMT was greater for cancer survivors than controls (0.46 mm (SD 0.12) vs. 0.41 mm (SD 0.06), P < 0.001). Plaque was present in 18% of irradiated vessels and 2% of non-irradiated vessels (P < 0.01). Among cancer survivors, IMT was positively associated with female gender (P < 0.05), non-white ethnicity (P < 0.01), positive family history of stroke/heart attack (P < 0.05), BMI (P < 0.001), total cholesterol (P < 0.01), cancer relapse (P < 0.001), and years off treatment (P < 0.0001). Plaque was positively associated with relapse (P < 0.05) and C-reactive protein (P < 0.01). There was no significant relationship between radiation dose at levels ≥2,000 cGy and IMT or plaque.

Conclusions

Carotid artery disease was more prevalent among cancer survivors treated with neck irradiation than among controls. Due to the high risk of stroke associated with advanced carotid disease, larger prospective studies are needed to better define disease risk in these long-term survivors. Pediatr Blood Cancer 2009;53:615–621. © 2009 Wiley-Liss, Inc.

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