{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T12:04:39Z","timestamp":1789646679251,"version":"4.0.0"},"reference-count":31,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2023,10,28]],"date-time":"2023-10-28T00:00:00Z","timestamp":1698451200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["acsjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Cancer"],"published-print":{"date-parts":[[2025,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Recipients of radiation therapy (RT) for head and neck cancer (HNC) are at significantly increased risk for carotid artery stenosis (CAS) and cerebrovascular disease (CVD). We sought to determine (1) cumulative incidences of CAS and CVD among HNC survivors after RT and (2) whether CAS is associated with a RT dose response effect.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This single\u2010institution retrospective cohort study examined patients with nonmetastatic HNC who completed (chemo)RT from January 2000 through October 2020 and subsequently received carotid imaging surveillance \u22642\u00a0years following RT completion and, in the absence of CAS, every 3 years thereafter. Exclusion criteria included history of known CAS\/CVD. Asymptomatic CAS was defined as \u226550% reduction of luminal diameter, symptomatic CAS as stroke or\u00a0transient ischemic attack, and composite CAS as asymptomatic or symptomatic\u00a0CAS.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Of 628 patients undergoing curative intent RT for HNC, median follow\u2010up was 4.8\u00a0years (interquartile range, 2.6\u20138.3), with 97 patients followed \u226510\u00a0years. Median age was 61\u00a0years and 69% of patients received concurrent chemotherapy and 28% were treated postoperatively. Actuarial 10\u2010year incidences of asymptomatic, symptomatic, and composite CAS were 29.6% (95% CI, 23.9\u201335.5), 10.1% (95% CI, 7.0\u201313.9), and 27.2% (95% CI, 22.5\u201332.1), respectively. Multivariable Cox models significant association between asymptomatic CAS and absolute carotid artery volume receiving \u226510 Gy (per mL: hazard ratio, 1.09; 95% CI, 1.02\u20131.16).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>HNC survivors are at high risk for post\u2010RT CAS. A dose response effect was observed for asymptomatic CAS at doses as low as 10\u00a0Gy.<\/jats:p><\/jats:sec><jats:sec><jats:title>Plain Language Summary<\/jats:title><jats:p>\n<jats:list list-type=\"bullet\">\n<jats:list-item><jats:p>Recipients of radiation therapy for head and neck cancer are at significantly increased risk for carotid artery stenosis and cerebrovascular disease. However, carotid artery screening is not routinely performed among head and neck survivors following radiation therapy.<\/jats:p><\/jats:list-item>\n<jats:list-item><jats:p>In this single\u2010institution retrospective cohort study, patients with head and neck cancer were initially screened for carotid artery stenosis \u22642\u00a0years following radiation therapy completion, then every 3 years thereafter.<\/jats:p><\/jats:list-item>\n<jats:list-item><jats:p>The 10\u2010year actuarial incidence of carotid artery stenosis was &gt;25% and stroke\/transient ischemic attack &gt;10%. Multivariable analysis demonstrated significant associations between asymptomatic carotid artery stenosis and artery volumes receiving \u226510\u00a0Gy.<\/jats:p><\/jats:list-item>\n<\/jats:list>\n<\/jats:p><\/jats:sec>","DOI":"10.1002\/cncr.35089","type":"journal-article","created":{"date-parts":[[2023,10,28]],"date-time":"2023-10-28T11:49:20Z","timestamp":1698493760000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":22,"title":["Long\u2010term risk of carotid stenosis and cerebrovascular disease after radiation therapy for head and neck cancer"],"prefix":"10.1002","volume":"131","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9261-7168","authenticated-orcid":false,"given":"David J.","family":"Carpenter","sequence":"first","affiliation":[{"name":"Department of Radiation Oncology Duke Cancer Institute  Durham North Carolina 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USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander K.","family":"Diaz","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology Duke Cancer Institute  Durham North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abhishek","family":"Kumar","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology Duke Cancer Institute  Durham North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9839-2414","authenticated-orcid":false,"given":"Yvonne M.","family":"Mowery","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology Duke Cancer Institute  Durham North Carolina USA"},{"name":"Department of Head and Neck Surgery and Communication Sciences Duke University Medical Center  Durham North Carolina 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