Prevalence of carotid stenosis following radiotherapy for head and neck cancer: A systematic review and meta-analysis.

ABSTRACT

BACKGROUND: Radiation to the head and neck is a well-established risk factor for the development of carotid artery stenosis. Our objective was to identify the prevalence, incidence, and degree of carotid stenosis in patients with a history of head and neck irradiation. METHODS: This study was performed according to the PRISMA guidelines. A random effects model meta-analysis was conducted. RESULTS: Nineteen studies comprising 1479 patients were included. The prevalence of carotid stenosis >50%, >70%, and carotid occlusion was 25% (95% CI 19%-32%), 12% (95% CI 7%-17%), and 4% (95% CI 2%-8%), respectively. The cumulative 12-month incidence of carotid stenosis >50% was 4% (95% CI 2%-5%), the 24-month was 12% (95% CI 9%-15%), and the 36-month was 21% (95% CI 9%-36%). CONCLUSIONS: The yearly incidence of carotid stenosis >50% increased every year during the first 3 years following radiotherapy. We propose routine yearly Doppler ultrasound screening beginning 1 year after head and neck radiotherapy.