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

Authors

Efstratios Koutroumpakis
Mohamed A Naser
Abdallah Sherif Radwan Mohamed
Salman A Eraj
Andrea Jarre
Jay C Shiao
Mona Kamal
Subha Perni
Jack P Phan
William H Morrison
Steven J Frank
G Brandon Gunn
Adam S Garden
Anita Deswal
Jun-Ichi Abe
David I Rosenthal
Elie Mouhayar
Clifton D Fuller

Publication Date

3-1-2025

Journal

Clinical and Translational Radiation Oncology

DOI

10.1016/j.ctro.2025.100912

PMID

39867727

PMCID

PMC11762641

Abstract

Aim: This study leveraged standard-of-care CT scans of patients receiving unilateral radiotherapy (RT) for early tonsillar cancer to detect volumetric changes in the carotid arteries, and determine whether there is a dose-response relationship.

Methods: Disease-free cancer survivors (>3 months since therapy and age > 18 years) treated with intensity modulated RT for early (T1-2, N0-2b) tonsillar cancer with pre- and post-therapy contrast-enhanced CT scans available were included. Patients treated with definitive surgery, bilateral RT, or additional RT before the post-RT CT scan were excluded. Isodose lines from treatment plans were projected onto both scans, facilitating the delineation of carotid artery subvolumes in 5 Gy increments (i.e. received 50-55 Gy, 55-60 Gy, etc.). The percent-change in sub-volumes across each dose range was examined.

Results: Among 46 patients, 72 % received RT alone, 24 % induction chemotherapy followed by RT, and 4 % concurrent chemoradiation. The median interval from RT completion to the latest, post-RT CT scan was 43 months (IQR 32-57). A decrease in the volume of the irradiated carotid artery was observed in 78 % of patients, while there was a statistically significant difference in mean %-change (±SD) between the total irradiated and spared carotid volumes (-7.0 ± 9.0 vs. + 3.5 ± 7.2, respectively, p < 0.0001). Chemotherapy use, in addition to RT, was associated with a significant mean %-decrease in carotid artery volume compared to RT alone. No significant dose-response trend was observed in the carotid artery volume change within 5 Gy ranges.

Conclusions: Our data show that standard-of-care oncologic surveillance CT scans can effectively detect reductions in carotid volume following RT for oropharyngeal cancer. Changes were equivalent between studied dose ranges, denoting no further dose-response effect beyond 50 Gy.

Keywords

Radiation therapy, Radiation-induced carotid artery disease, Carotid artery volumetry, Computed tomography, Tonsillar cancer, Head and neck cancer

Published Open-Access

yes

Recommended Citation

Koutroumpakis, Efstratios; Naser, Mohamed A; Radwan Mohamed, Abdallah Sherif; et al., "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" (2025). Faculty, Staff and Student Publications. 1264.
https://digitalcommons.library.tmc.edu/uthgsbs_docs/1264