{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,9]],"date-time":"2026-03-09T04:04:40Z","timestamp":1773029080178,"version":"3.50.1"},"reference-count":24,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2020,5,7]],"date-time":"2020-05-07T00:00:00Z","timestamp":1588809600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2020,5,7]],"date-time":"2020-05-07T00:00:00Z","timestamp":1588809600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100010687","name":"H2020 Euratom","doi-asserted-by":"publisher","award":["755523"],"award-info":[{"award-number":["755523"]}],"id":[{"id":"10.13039\/100010687","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Radiat Oncol"],"published-print":{"date-parts":[[2020,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>Radiotherapy treatment of head and neck cancer affects local arteries and increases the risk of stroke. This study aimed at a closer characterization of this damage and its development in time with a longitudinal study set up.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>Male patients treated between 2011 and 2016 for hypopharyngeal carcinoma were identified from the in-house clinical data base. They were included into the study if besides the planning CT at least one additional CT image was available from follow-up (13 patients) or at least two MRI scans (16 patients of which 2 were already included). All patients received radiotherapy, and chemotherapy was administered to 16 patients. The time from the beginning of radiotherapy to the last available image ranged from 2\u2009months to 4.5\u2009years.<\/jats:p>\n                <jats:p>For six segments of the carotid arteries, the number and volume of atherosclerotic plaques were determined from the CT scans, and the intima media thickness from the MRI scans. Information on comorbid cardiovascular disease, hypertension and diabetes mellitus was retrieved from medical records.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>Total plaque volume rose from 0.25\u2009cm<jats:sup>3<\/jats:sup> before to 0.33\u2009cm<jats:sup>3<\/jats:sup> after therapy but this was not significant (<jats:italic>p<\/jats:italic>\u2009=\u20090.26). The mean number of plaques increased from 5.7 to 8.1 (<jats:italic>p<\/jats:italic>\u2009=\u20090.002), and the intima media thickened from 1.17\u2009mm to 1.35\u2009mm (p\u2009=\u20090.002). However, the mean intima media thickness practically did not change in patients with comorbid diabetes mellitus (<jats:italic>p<\/jats:italic>-value for homogeneity: 0.03). For patients without diabetes mellitus, dynamics of both plaque number and intima media thickness, was consistent with an increase until about one year after therapy and no further progression thereafter.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusion<\/jats:title>\n                <jats:p>Our study confirmed the thickening of artery walls and the increase in the number of plaques. Results imply that definitive radiation damage to the artery walls can be determined not earlier than about one year after radiotherapy and there is no substantial deterioration thereafter. Reasons for the absence of an observable intima media thickening in patients with diabetes are unclear.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s13014-020-01541-3","type":"journal-article","created":{"date-parts":[[2020,5,7]],"date-time":"2020-05-07T12:02:57Z","timestamp":1588852977000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Longitudinal atherosclerotic changes after radio(chemo)therapy of hypopharyngeal carcinoma"],"prefix":"10.1186","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4816-3514","authenticated-orcid":false,"given":"Cristoforo","family":"Simonetto","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael","family":"Mayinger","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thamer","family":"Ahmed","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kai","family":"Borm","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pavel","family":"Kundr\u00e1t","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Steffi","family":"Pigorsch","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jan Christian","family":"Kaiser","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stephanie E.","family":"Combs","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2020,5,7]]},"reference":[{"issue":"9","key":"1541_CR1","doi-asserted-by":"publisher","first-page":"2410","DOI":"10.1161\/STROKEAHA.111.615203","volume":"42","author":"C Plummer","year":"2011","unstructured":"Plummer C, Henderson RD, O'Sullivan JD, Read SJ. Ischemic stroke and transient ischemic attack after head and neck radiotherapy: a review. Stroke. 2011;42(9):2410\u20138. https:\/\/doi.org\/10.1161\/STROKEAHA.111.615203.","journal-title":"Stroke"},{"issue":"5","key":"1541_CR2","doi-asserted-by":"publisher","first-page":"771","DOI":"10.1016\/j.amjcard.2016.06.001","volume":"118","author":"P Vallerio","year":"2016","unstructured":"Vallerio P, Sarno L, Stucchi M, Musca F, Casadei F, Maloberti A, Lestuzzi C, Mancia G, Moreo A, Palazzi M, Giannattasio C. Long-term effects of radiotherapy on arterial stiffness in breast Cancer women. Am J Cardiol. 2016;118(5):771\u20136. https:\/\/doi.org\/10.1016\/j.amjcard.2016.06.001.","journal-title":"Am J Cardiol"},{"issue":"10","key":"1541_CR3","doi-asserted-by":"publisher","first-page":"1135","DOI":"10.1001\/archotol.1991.01870220083014","volume":"117","author":"RS Feehs","year":"1991","unstructured":"Feehs RS, McGuirt WF, Bond MG, Strickland HL, Craven TE, Hiltbrand JB. Irradiation. A significant risk factor for carotid atherosclerosis. Arch Otolaryngol Head Neck Surg. 1991;117(10):1135\u20137.","journal-title":"Arch Otolaryngol Head Neck Surg"},{"issue":"848","key":"1541_CR4","doi-asserted-by":"publisher","first-page":"872","DOI":"10.1259\/bjr.71.848.9828801","volume":"71","author":"JJ Dubec","year":"1998","unstructured":"Dubec JJ, Munk PL, Tsang V, Lee MJ, Janzen DL, Buckley J, Seal M, Taylor D. Carotid artery stenosis in patients who have undergone radiation therapy for head and neck malignancy. Br J Radiol. 1998;71(848):872\u20135. https:\/\/doi.org\/10.1259\/bjr.71.848.9828801.","journal-title":"Br J Radiol"},{"issue":"4","key":"1541_CR5","doi-asserted-by":"publisher","first-page":"323","DOI":"10.1016\/S0002-9610(99)00184-1","volume":"178","author":"SW Cheng","year":"1999","unstructured":"Cheng SW, Wu LL, Ting AC, Lau H, Lam LK, Wei WI. Irradiation-induced extracranial carotid stenosis in patients with head and neck malignancies. Am J Surg. 1999;178(4):323\u20138.","journal-title":"Am J Surg"},{"issue":"1","key":"1541_CR6","doi-asserted-by":"publisher","first-page":"72","DOI":"10.1007\/s00330-015-3753-9","volume":"26","author":"M Anzidei","year":"2016","unstructured":"Anzidei M, Suri JS, Saba L, Sanfilippo R, Laddeo G, Montisci R, Piga M, Argiolas GM, Raz E. Longitudinal assessment of carotid atherosclerosis after radiation therapy using computed tomography: a case control study. Eur Radiol. 2016;26(1):72\u20138. https:\/\/doi.org\/10.1007\/s00330-015-3753-9.","journal-title":"Eur Radiol"},{"issue":"4","key":"1541_CR7","doi-asserted-by":"publisher","first-page":"1197","DOI":"10.1016\/j.ijrobp.2005.04.017","volume":"63","author":"JD Martin","year":"2005","unstructured":"Martin JD, Buckley AR, Graeb D, Walman B, Salvian A, Hay JH. Carotid artery stenosis in asymptomatic patients who have received unilateral head-and-neck irradiation. Int J Radiat Oncol Biol Phys. 2005;63(4):1197\u2013205. https:\/\/doi.org\/10.1016\/j.ijrobp.2005.04.017.","journal-title":"Int J Radiat Oncol Biol Phys"},{"issue":"1","key":"1541_CR8","doi-asserted-by":"publisher","first-page":"35","DOI":"10.3988\/jcn.2018.14.1.35","volume":"14","author":"BJ Kim","year":"2018","unstructured":"Kim BJ, Kang HG, Lee SW, Jung J, Lee MH, Kang DW, Kim JS, Kwon SU. Changes in the common carotid artery after radiotherapy: wall thickness, calcification, and atherosclerosis. J Clin Neurol. 2018;14(1):35\u201342. https:\/\/doi.org\/10.3988\/jcn.2018.14.1.35.","journal-title":"J Clin Neurol"},{"issue":"8","key":"1541_CR9","doi-asserted-by":"publisher","first-page":"1175","DOI":"10.3109\/0284186X.2015.1023901","volume":"54","author":"J Wilbers","year":"2015","unstructured":"Wilbers J, Meijer FJ, Kappelle AC, Kaanders JH, Boogerd W, Dorresteijn LD, van Dijk EJ, Steens SC. Magnetic resonance imaging of the carotid artery in long-term head and neck cancer survivors treated with radiotherapy. Acta Oncol. 2015;54(8):1175\u201380. https:\/\/doi.org\/10.3109\/0284186X.2015.1023901.","journal-title":"Acta Oncol"},{"issue":"1050","key":"1541_CR10","doi-asserted-by":"publisher","first-page":"20150175","DOI":"10.1259\/bjr.20150175","volume":"88","author":"L Zhou","year":"2015","unstructured":"Zhou L, Xing P, Chen Y, Xu X, Shen J, Lu X. Carotid and vertebral artery stenosis evaluated by contrast-enhanced MR angiography in nasopharyngeal carcinoma patients after radiotherapy: a prospective cohort study. Br J Radiol. 2015;88(1050):20150175. https:\/\/doi.org\/10.1259\/bjr.20150175.","journal-title":"Br J Radiol"},{"issue":"10","key":"1541_CR11","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0110389","volume":"9","author":"K Bashar","year":"2014","unstructured":"Bashar K, Healy D, Clarke-Moloney M, Burke P, Kavanagh E, Walsh SR. Effects of neck radiation therapy on extra-cranial carotid arteries atherosclerosis disease prevalence: systematic review and a meta-analysis. PLoS One. 2014;9(10):e110389. https:\/\/doi.org\/10.1371\/journal.pone.0110389.","journal-title":"PLoS One"},{"issue":"11","key":"1541_CR12","doi-asserted-by":"publisher","first-page":"1811","DOI":"10.1097\/00005537-200011000-00007","volume":"110","author":"K Muzaffar","year":"2000","unstructured":"Muzaffar K, Collins SL, Labropoulos N, Baker WH. A prospective study of the effects of irradiation on the carotid artery. Laryngoscope. 2000;110(11):1811\u20134. https:\/\/doi.org\/10.1097\/00005537-200011000-00007.","journal-title":"Laryngoscope"},{"issue":"4","key":"1541_CR13","doi-asserted-by":"publisher","first-page":"977","DOI":"10.1161\/01.str.0000013562.73522.82","volume":"33","author":"LJ Walker","year":"2002","unstructured":"Walker LJ, Ismail A, McMeekin W, Lambert D, Mendelow AD, Birchall D. Computed tomography angiography for the evaluation of carotid atherosclerotic plaque: correlation with histopathology of endarterectomy specimens. Stroke. 2002;33(4):977\u201381. https:\/\/doi.org\/10.1161\/01.str.0000013562.73522.82.","journal-title":"Stroke"},{"issue":"9","key":"1541_CR14","doi-asserted-by":"publisher","first-page":"872","DOI":"10.1016\/j.oraloncology.2003.12.005","volume":"40","author":"OK Abayomi","year":"2004","unstructured":"Abayomi OK. Neck irradiation, carotid injury and its consequences. Oral Oncol. 2004;40(9):872\u20138. https:\/\/doi.org\/10.1016\/j.oraloncology.2003.12.005.","journal-title":"Oral Oncol"},{"issue":"1","key":"1541_CR15","doi-asserted-by":"publisher","first-page":"31","DOI":"10.1016\/j.radonc.2013.08.009","volume":"110","author":"DM Gujral","year":"2014","unstructured":"Gujral DM, Chahal N, Senior R, Harrington KJ, Nutting CM. Radiation-induced carotid artery atherosclerosis. Radiother Oncol. 2014;110(1):31\u20138. https:\/\/doi.org\/10.1016\/j.radonc.2013.08.009.","journal-title":"Radiother Oncol"},{"issue":"4","key":"1541_CR16","doi-asserted-by":"publisher","first-page":"183","DOI":"10.1159\/000363068","volume":"2","author":"J Xu","year":"2014","unstructured":"Xu J, Cao Y. Radiation-induced carotid artery stenosis: a comprehensive review of the literature. Interv Neurol. 2014;2(4):183\u201392. https:\/\/doi.org\/10.1159\/000363068.","journal-title":"Interv Neurol"},{"issue":"2","key":"1541_CR17","doi-asserted-by":"publisher","first-page":"409","DOI":"10.1016\/j.jvs.2003.08.031","volume":"39","author":"SW Cheng","year":"2004","unstructured":"Cheng SW, Ting AC, Ho P, Wu LL. Accelerated progression of carotid stenosis in patients with previous external neck irradiation. J Vasc Surg. 2004;39(2):409\u201315. https:\/\/doi.org\/10.1016\/j.jvs.2003.08.031.","journal-title":"J Vasc Surg"},{"issue":"2","key":"1541_CR18","doi-asserted-by":"publisher","first-page":"280","DOI":"10.1016\/j.jvs.2009.01.033","volume":"50","author":"YJ Chang","year":"2009","unstructured":"Chang YJ, Chang TC, Lee TH, Ryu SJ. Predictors of carotid artery stenosis after radiotherapy for head and neck cancers. J Vasc Surg. 2009;50(2):280\u20135. https:\/\/doi.org\/10.1016\/j.jvs.2009.01.033.","journal-title":"J Vasc Surg"},{"issue":"12","key":"1541_CR19","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0116284","volume":"9","author":"C Yuan","year":"2014","unstructured":"Yuan C, Wu VW, Yip SP, Kwong DL, Ying M. Predictors of the extent of carotid atherosclerosis in patients treated with radiotherapy for nasopharyngeal carcinoma. PLoS One. 2014;9(12):e116284. https:\/\/doi.org\/10.1371\/journal.pone.0116284.","journal-title":"PLoS One"},{"issue":"2","key":"1541_CR20","doi-asserted-by":"publisher","first-page":"323","DOI":"10.1016\/j.radonc.2015.11.025","volume":"118","author":"DM Gujral","year":"2016","unstructured":"Gujral DM, Shah BN, Chahal NS, Bhattacharyya S, Hooper J, Senior R, Harrington KJ, Nutting CM. Carotid intima-medial thickness as a marker of radiation-induced carotid atherosclerosis. Radiother Oncol. 2016;118(2):323\u20139. https:\/\/doi.org\/10.1016\/j.radonc.2015.11.025.","journal-title":"Radiother Oncol"},{"issue":"7","key":"1541_CR21","doi-asserted-by":"publisher","first-page":"1026","DOI":"10.1016\/j.ejca.2005.01.020","volume":"41","author":"LD Dorresteijn","year":"2005","unstructured":"Dorresteijn LD, Kappelle AC, Scholz NM, Munneke M, Scholma JT, Balm AJ, Bartelink H, Boogerd W. Increased carotid wall thickening after radiotherapy on the neck. Eur J Cancer. 2005;41(7):1026\u201330. https:\/\/doi.org\/10.1016\/j.ejca.2005.01.020.","journal-title":"Eur J Cancer"},{"key":"1541_CR22","doi-asserted-by":"publisher","first-page":"261","DOI":"10.1186\/1748-717X-8-261","volume":"8","author":"TL Huang","year":"2013","unstructured":"Huang TL, Hsu HC, Chen HC, Lin HC, Chien CY, Fang FM, Huang CC, Chang HW, Chang WN, Huang CR, Tsai NW, Kung CT, Wang HC, Lin WC, Cheng BC, Su YJ, Chang YT, Chang CR, Tan TY, Lu CH. Long-term effects on carotid intima-media thickness after radiotherapy in patients with nasopharyngeal carcinoma. Radiat Oncol. 2013;8:261. https:\/\/doi.org\/10.1186\/1748-717X-8-261.","journal-title":"Radiat Oncol"},{"issue":"9","key":"1541_CR23","doi-asserted-by":"publisher","first-page":"566","DOI":"10.1002\/jcu.21971","volume":"40","author":"U Toprak","year":"2012","unstructured":"Toprak U, Aytas I, Ustuner E, Habiboglu R, Aslan N, Pasaoglu E, Karademir A. Sonographic assessment of acute changes in plaque size and echogenicity and in intima-media thickness of carotid arteries after neck radiation therapy. J Clin Ultrasound. 2012;40(9):566\u201371. https:\/\/doi.org\/10.1002\/jcu.21971.","journal-title":"J Clin Ultrasound"},{"issue":"11","key":"1541_CR24","doi-asserted-by":"publisher","first-page":"3257","DOI":"10.1161\/STROKEAHA.114.005669","volume":"45","author":"MC Tattersall","year":"2014","unstructured":"Tattersall MC, Gassett A, Korcarz CE, Gepner AD, Kaufman JD, Liu KJ, Astor BC, Sheppard L, Kronmal RA, Stein JH. Predictors of carotid thickness and plaque progression during a decade: the multi-ethnic study of atherosclerosis. Stroke. 2014;45(11):3257\u201362. https:\/\/doi.org\/10.1161\/STROKEAHA.114.005669.","journal-title":"Stroke"}],"container-title":["Radiation Oncology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s13014-020-01541-3.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s13014-020-01541-3\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s13014-020-01541-3.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,5,6]],"date-time":"2021-05-06T23:27:00Z","timestamp":1620343620000},"score":1,"resource":{"primary":{"URL":"https:\/\/ro-journal.biomedcentral.com\/articles\/10.1186\/s13014-020-01541-3"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,5,7]]},"references-count":24,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2020,12]]}},"alternative-id":["1541"],"URL":"https:\/\/doi.org\/10.1186\/s13014-020-01541-3","relation":{},"ISSN":["1748-717X"],"issn-type":[{"value":"1748-717X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,5,7]]},"assertion":[{"value":"4 October 2019","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"22 April 2020","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"7 May 2020","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The ethics committee of Klinikum rechts der Isar, TU M\u00fcnchen has approved this study.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare that they have no competing interests.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"102"}}