Ultrasound Evaluation of Carotid Atherosclerosis in Post-Radiotherapy Nasopharyngeal Carcinoma Patients, Type 2 Diabetics, and Healthy Controls

Abstract

Purpose To comprehensively evaluate and compare the degree of carotid atherosclerosis in patients treated with radiotherapy (RT) for nasopharyngeal carcinoma (NPC) and in patients with type 2 diabetes mellitus (DM), and using healthy subjects as controls.

Materials and Methods The present study recruited 69 post-RT NPC patients without conventional cardiovascular risk factors, 70 type 2 diabetic patients without previous RT, and 76 healthy controls without conventional cardiovascular risk factors and previous RT. For each participant, 5 carotid atherosclerotic parameters, namely carotid intima-media thickness (CIMT), carotid arterial stiffness (CAS), presence of carotid plaque, carotid plaque score, and presence of ≥ 50 % carotid stenosis, were assessed using ultrasonography. The differences in these carotid atherosclerotic parameters between study groups were compared using ANCOVA or logistic regression after the adjustment for age and gender. Multiple comparisons were corrected using the Benjamini-Hochberg false discovery rate.

Results Post-RT NPC patients and type 2 diabetics had a significantly higher CIMT, CAS and carotid plaque burden compared to the healthy subjects (corrected P-value, Pcor < 0.05). In addition, carotid atherosclerosis in post-RT NPC patients tended to be more severe with significantly higher CAS and carotid plaque burden than that in type 2 diabetics (Pcor < 0.05).

Conclusion Neck RT for NPC is an independent risk factor of carotid atherosclerosis, and radiation induces more severe carotid atherosclerosis in post-RT NPC patients. Thus, assessment of carotid atherosclerosis using ultrasonography may be necessary for these patients and should be indicated in the routine follow-up of NPC.

Zusammenfassung

Ziel Umfassende Bewertung und Vergleich des Arteriosklerosegrades der Karotis bei Patienten mit Nasopharynxkarzinom (NPC), bei denen eine Radiotherapie (RT) durchgeführt wurde, bei Patienten mit Diabetes-Typ-2 (DM) sowie bei gesunden Kontrollprobanden.

Material und Methoden Diese aktuelle Studie rekrutierte 69 post-RT NPC-Patienten, die keine üblichen kardiovaskulären Risikofaktoren hatten, 70 Patienten mit Diabetes Typ-2 ohne vorherige RT und 76 gesunden Kontrollprobanden ohne kardiovaskuläre Risikofaktoren und ohne vorherige RT. Für jeden Teilnehmer wurden sonografisch 5 Parameter einer Karotis-Arteriosklerose ermittelt, die Karotis-Intima-Media-Dicke (CIMT), die Steifigkeit der Karotisarterie (CAS), das Vorhandensein einer Karotisplaque, der Karotisplaque-Grad und das Auftreten einer ≥ 50 % Karotisstenose. Unterschiede dieser Karotis-Arteriosklerose-Parameter zwischen den Studiengruppen wurden mittels ANCOVA oder logistischer Regression nach Anpassung von Alter und Geschlecht verglichen. Multiple Vergleiche wurden mit der „False Discovery Rate“ (Benjamini-Hochberg-Prozedur) korrigiert.

Ergebnisse Die Patienten mit NPC nach RT und mit Diabetes-Typ-2 hatten signifikant höhere CIMT-, CAS- und Karotisplaque-Lasten im Vergleich zu gesunden Probanden (korrigierter P-Wert, Pcor < 0,05). Darüber hinaus schien die Karotisstenose von NPC-Patienten nach RT noch schwerer zu verlaufen mit signifikant höheren CAS und Karotisplaque-Lasten als in Typ-2-Diabetikern (Pcor < 0,05).

Schlussfolgerung Die Radiotherapie am Hals ist bei NPC ein unabhängiger Risikofaktor für eine Arteriosklerose der A. carotis, sie induziert eine hochgradige Karotis-Arteriosklerose. Daher sollte die sonografische Untersuchung auf eine Karotisstenose bei Patienten mit NPC Bestandteil der Routine-Nachsorge sein.

Key words

carotid arteries - tumor - radiation effects - ultrasound - arteriosclerosis

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