{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"institution":[{"name":"medRxiv"}],"indexed":{"date-parts":[[2026,1,16]],"date-time":"2026-01-16T13:52:44Z","timestamp":1768571564053,"version":"3.49.0"},"posted":{"date-parts":[[2025,9,12]]},"group-title":"Cardiovascular Medicine","reference-count":27,"publisher":"openRxiv","license":[{"start":{"date-parts":[[2025,9,12]],"date-time":"2025-09-12T00:00:00Z","timestamp":1757635200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"accepted":{"date-parts":[[2025,9,12]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Afferent baroreflex failure (ABF) is an underrecognized but debilitating complication among head and neck cancer survivors, especially in oropharyngeal cancer (OPC), a malignancy with excellent prognosis. ABF is mainly caused by radiation therapy (RT), with neck surgery and some chemotherapies also contributing. It manifests as blood pressure lability, including severe hypertension or hypotension, syncope, and arrhythmias.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Objectives<\/jats:title>\n                  <jats:p>To determine the prevalence and predictors of ABF-associated manifestations among OPC survivors treated with modern RT.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We retrospectively studied OPC patients treated with RT at a tertiary cancer center between 2016\u20132019. Clinical data were collected from RT initiation to last follow-up or death. ABF-associated manifestations included new or worsening hypertension, hypotension requiring intervention, arrhythmias, and syncope. Secondary endpoints included new or worsened carotid artery atherosclerosis, stenosis, transient ischemic attack (TIA), stroke, and all-cause mortality.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Among 393 patients (88% men, 91% White, mean age 61\u00b110 years), 9.4% developed hypertension, 5.3% hypotension, 3.8% syncope, and 3.3% arrhythmias over median 6.3-year follow-up. Overall, 19.1% developed at least one ABF-associated manifestations. New or worsened carotid atherosclerosis occurred in 38.9%, with 7.1% developing &gt;50% stenosis and 2.3% experiencing TIA or stroke. Mortality was 21.4%. On cause-specific multivariable Cox analysis, older age (adjusted hazard ratio [aHR] 1.03; 95% confidence interval [CI] 1.01\u20131.06), valvular disease (aHR 2.85; CI 1.03\u20137.92), T4 cancer (aHR 1.90; CI 1.10\u20133.27), and platinum-taxane chemotherapy (aHR 1.86; CI 1.13\u20133.05) independently increased risk of ABF-associated manifestations.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Nearly 1 in 5 OPC survivors treated with RT develop ABF-associated manifestations, highlighting the need for early recognition and surveillance.<\/jats:p>\n                <\/jats:sec>","DOI":"10.1101\/2025.09.08.25335364","type":"posted-content","created":{"date-parts":[[2025,9,13]],"date-time":"2025-09-13T00:10:39Z","timestamp":1757722239000},"source":"Crossref","is-referenced-by-count":0,"title":["Prevalence of Manifestations of Afferent Baroreflex Failure Among Long-Term Survivors of Oropharyngeal Cancer"],"prefix":"10.64898","author":[{"given":"Patrik J.","family":"Van-Bergen","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dhawal S.","family":"Bandrey","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Juhee","family":"Song","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stephen P.","family":"Patin","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Neeharika","family":"Prathapa","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gabrielle N.","family":"Mbagwu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andres","family":"Hughes","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jennifer","family":"Shen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mohamed A.","family":"Naser","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Katherine A.","family":"Hutcheson","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David I.","family":"Rosenthal","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Amy C.","family":"Moreno","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elie","family":"Mouhayar","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anita","family":"Deswal","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Clifton D.","family":"Fuller","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Efstratios","family":"Koutroumpakis","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"name":"OPC-SURVIVOR Program","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"54368","reference":[{"key":"2025091504050899000_2025.09.08.25335364v1.1","doi-asserted-by":"crossref","first-page":"1369","DOI":"10.1200\/JCO-24-02755","article-title":"Transoral Robotic Surgery in the Multidisciplinary Care of Patients With Oropharyngeal Squamous Cell Carcinoma: ASCO Guideline","volume":"43","year":"2025","journal-title":"J Clin Oncol"},{"key":"2025091504050899000_2025.09.08.25335364v1.2","doi-asserted-by":"publisher","DOI":"10.1002\/hed.26102"},{"key":"2025091504050899000_2025.09.08.25335364v1.3","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra1509723"},{"key":"2025091504050899000_2025.09.08.25335364v1.4","doi-asserted-by":"crossref","first-page":"788","DOI":"10.1016\/j.jaccao.2024.09.004","article-title":"Autonomic Dysfunction Among Adult Survivors of Childhood Cancer","volume":"6","year":"2024","journal-title":"JACC CardioOncol"},{"key":"2025091504050899000_2025.09.08.25335364v1.5","doi-asserted-by":"crossref","unstructured":"Lamotte G , Coon EA , Suarez MD , et al. Natural History of Afferent Baroreflex Failure in Adults. Neurology. 2021;97.","DOI":"10.1212\/WNL.0000000000012149"},{"key":"2025091504050899000_2025.09.08.25335364v1.6","doi-asserted-by":"crossref","first-page":"2784","DOI":"10.1007\/s00415-022-11552-7","article-title":"Baroreflex failure as a long-term sequela of head and neck irradiation","volume":"270","year":"2023","journal-title":"J Neurol"},{"key":"2025091504050899000_2025.09.08.25335364v1.7","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2019.10.027"},{"key":"2025091504050899000_2025.09.08.25335364v1.8","doi-asserted-by":"crossref","first-page":"2573","DOI":"10.1007\/s00415-024-12197-4","article-title":"Progression rate of radiation-induced carotid stenosis in head and neck cancer survivors after statin treatment: a retrospective cohort study","volume":"271","year":"2024","journal-title":"J Neurol"},{"key":"2025091504050899000_2025.09.08.25335364v1.9","doi-asserted-by":"crossref","first-page":"666","DOI":"10.1016\/j.clinph.2020.11.024","article-title":"Electrodiagnostic assessment of the autonomic nervous system: A consensus statement endorsed by the American Autonomic Society, American Academy of Neurology, and the International Federation of Clinical Neurophysiology","volume":"132","year":"2021","journal-title":"Clin Neurophysiol"},{"key":"2025091504050899000_2025.09.08.25335364v1.10","doi-asserted-by":"crossref","unstructured":"Fradley MG , Beckie TM , Brown SA , et al. Recognition, Prevention, and Management of Arrhythmias and Autonomic Disorders in Cardio-Oncology: A Scientific Statement From the American Heart Association. Circulation. 2021;144.","DOI":"10.1161\/CIR.0000000000000986"},{"key":"2025091504050899000_2025.09.08.25335364v1.11","doi-asserted-by":"crossref","first-page":"553","DOI":"10.1097\/HJH.0000000000002286","article-title":"Severe impaired blood pressure control caused by baroreflex failure as a late sequela of neck irradiation","volume":"38","year":"2020","journal-title":"J Hypertens"},{"key":"2025091504050899000_2025.09.08.25335364v1.12","doi-asserted-by":"crossref","first-page":"50","DOI":"10.1161\/HYPERTENSIONAHA.121.17805","article-title":"Standardized Autonomic Testing in Patients With Probable Radiation-Induced Afferent Baroreflex Failure","volume":"79","year":"2022","journal-title":"Hypertension"},{"key":"2025091504050899000_2025.09.08.25335364v1.13","doi-asserted-by":"publisher","DOI":"10.1259\/bjr\/31372149"},{"key":"2025091504050899000_2025.09.08.25335364v1.14","first-page":"77","article-title":"Considerations regarding carotid artery dose in radiotherapy of the cervical spine","volume":"38","year":"2023","journal-title":"Clin Transl Radiat Oncol"},{"key":"2025091504050899000_2025.09.08.25335364v1.15","doi-asserted-by":"crossref","first-page":"7712","DOI":"10.1038\/s41598-025-92710-5","article-title":"Responses of the carotid artery to acute, fractionated or chronic ionizing irradiation, and differences from the aorta","volume":"15","year":"2025","journal-title":"Sci Rep"},{"key":"2025091504050899000_2025.09.08.25335364v1.16","doi-asserted-by":"crossref","first-page":"104585","DOI":"10.1016\/j.canrad.2024.05.009","article-title":"Hypertension and hypotension due to baroreceptors dysfunction: A physician personal experience as a head and neck cancer patient","volume":"29","year":"2025","journal-title":"Cancer\/Radioth\u00e9rapie"},{"key":"2025091504050899000_2025.09.08.25335364v1.17","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1161\/HYPERTENSIONAHA.121.18372","article-title":"Evaluation and Diagnosis of Afferent Baroreflex Failure","volume":"79","year":"2022","journal-title":"Hypertension"},{"key":"2025091504050899000_2025.09.08.25335364v1.18","doi-asserted-by":"crossref","first-page":"129","DOI":"10.1016\/j.radonc.2022.03.004","article-title":"Concurrent chemoradiation therapy is associated with an accelerated risk of cardiovascular autonomic dysfunction in patients with nasopharyngeal carcinoma: A 9-year prospective follow-up study","volume":"170","year":"2022","journal-title":"Radiother Oncol"},{"key":"2025091504050899000_2025.09.08.25335364v1.19","doi-asserted-by":"publisher","DOI":"10.1186\/1748-717X-8-21"},{"key":"2025091504050899000_2025.09.08.25335364v1.20","doi-asserted-by":"crossref","first-page":"1228","DOI":"10.1002\/cncr.33370","article-title":"Conditional survival among patients with oropharyngeal cancer treated with radiation therapy and alive without recurrence 5 years after diagnosis","volume":"127","year":"2021","journal-title":"Cancer"},{"key":"2025091504050899000_2025.09.08.25335364v1.21","doi-asserted-by":"crossref","first-page":"110200","DOI":"10.1016\/j.radonc.2024.110200","article-title":"Neurological complications of modern radiotherapy for head and neck cancer","volume":"194","year":"2024","journal-title":"Radiother Oncol"},{"key":"2025091504050899000_2025.09.08.25335364v1.22","doi-asserted-by":"crossref","first-page":"1345811","DOI":"10.3389\/fnmol.2024.1345811","article-title":"Current understanding of the molecular mechanisms of chemotherapy-induced peripheral neuropathy","volume":"17","year":"2024","journal-title":"Front Mol Neurosci"},{"key":"2025091504050899000_2025.09.08.25335364v1.23","doi-asserted-by":"crossref","first-page":"1673","DOI":"10.1007\/s12640-022-00582-8","article-title":"Neurophysiopathological Aspects of Paclitaxel-induced Peripheral Neuropathy","volume":"40","year":"2022","journal-title":"Neurotox Res"},{"key":"2025091504050899000_2025.09.08.25335364v1.24","doi-asserted-by":"crossref","first-page":"575","DOI":"10.1093\/jrr\/rrae068","article-title":"Radiation-associated cardiovascular disease in patients with cancer: current insights from a cardio-oncologist","volume":"65","year":"2024","journal-title":"J Radiat Res (Tokyo)"},{"key":"2025091504050899000_2025.09.08.25335364v1.25","doi-asserted-by":"crossref","first-page":"110220","DOI":"10.1016\/j.radonc.2024.110220","article-title":"Longitudinal changes in the carotid arteries of head and neck cancer patients following radiation therapy: Results from a prospective serial imaging biomarker characterization study","volume":"195","year":"2024","journal-title":"Radiother Oncol"},{"key":"2025091504050899000_2025.09.08.25335364v1.26","first-page":"100912","article-title":"Detection of alteration in carotid artery volumetry using standard-of-care computed tomography surveillance scans following unilateral radiation therapy for early-stage tonsillar squamous cell carcinoma survivors: a cross-sectional internally-matched carotid isodose analysis","volume":"51","year":"2025","journal-title":"Clin Transl Radiat Oncol"},{"key":"2025091504050899000_2025.09.08.25335364v1.27","doi-asserted-by":"publisher","DOI":"10.1002\/hed.24789"}],"container-title":[],"original-title":[],"link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1101\/2025.09.08.25335364","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,15]],"date-time":"2026-01-15T20:45:22Z","timestamp":1768509922000},"score":1,"resource":{"primary":{"URL":"http:\/\/medrxiv.org\/lookup\/doi\/10.1101\/2025.09.08.25335364"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9,12]]},"references-count":27,"URL":"https:\/\/doi.org\/10.1101\/2025.09.08.25335364","relation":{},"subject":[],"published":{"date-parts":[[2025,9,12]]},"subtype":"preprint"}}