<abstract xmlns="http://www.w3.org/1999/xhtml">

<sec id="j_raon-2018-0006_s_005">
<h3>Background</h3>
<p>The risk for cerebrovascular late effects among childhood cancer survivors is considerable. According to recent studies it is not clear which marker could be reliable for the screening of cerebrovascular diseases among the long-term survivors of childhood cancer. The purpose of this study is to analyse arterial stiffness and intima-media thickness as possible early markers of later occurring stroke in long-term survivors of childhood cancer after neck radiotherapy.</p></sec>
<sec id="j_raon-2018-0006_s_006">
<h3>Patients and methods</h3>
<p>Twenty-three patients, treated for Hodgkin disease (HD) in childhood, were included. They had received radiation therapy to the neck with 20–65 (median 30) Gy. Twenty-six healthy controls, matched in age, sex, body mass index, arterial hypertension, smoking history and total cholesterol levels were compared. Highresolution colour-coded duplex sonography and power Doppler sonography of the carotid arteries were performed and intima-media thickness, number and quality of plaques were measured. Arterial stiffness indices were calculated.</p></sec>
<sec id="j_raon-2018-0006_s_007">
<h3>Results</h3>
<p>Plaque deposits and/or arterial wall calcinations were found in 24 out of 43 (55.8%) irradiated vessels in cancer survivors group and 0 out of 52 vessels in the group of healthy controls (p &lt; 0.01). We found significant group differences for all the stiffness parameters we used (P &lt; 0.05), but there was no difference in intima-media thickness between cases and controls (p = 0.92). In a multivariate model, carotid pulse wave velocity was positively associated with smoking.</p></sec>
<sec id="j_raon-2018-0006_s_008">
<h3>Conclusions</h3>
<p>The arterial stiffness has appeared as a possible surrogate marker for stroke in long-term survivors of childhood cancer. Smoking habit might have an additional negative influence on vascular aging in the group of patients after neck radiotherapy.</p></sec></abstract>

Background
The risk for cerebrovascular late effects among childhood cancer survivors is considerable. According to recent studies it is not clear which marker could be reliable for the screening of cerebrovascular diseases among the long-term survivors of childhood cancer. The purpose of this study is to analyse arterial stiffness and intima-media thickness as possible early markers of later occurring stroke in long-term survivors of childhood cancer after neck radiotherapy.

Patients and methods
Twenty-three patients, treated for Hodgkin disease (HD) in childhood, were included. They had received radiation therapy to the neck with 20–65 (median 30) Gy. Twenty-six healthy controls, matched in age, sex, body mass index, arterial hypertension, smoking history and total cholesterol levels were compared. Highresolution colour-coded duplex sonography and power Doppler sonography of the carotid arteries were performed and intima-media thickness, number and quality of plaques were measured. Arterial stiffness indices were calculated.

Results
Plaque deposits and/or arterial wall calcinations were found in 24 out of 43 (55.8%) irradiated vessels in cancer survivors group and 0 out of 52 vessels in the group of healthy controls (p < 0.01). We found significant group differences for all the stiffness parameters we used (P < 0.05), but there was no difference in intima-media thickness between cases and controls (p = 0.92). In a multivariate model, carotid pulse wave velocity was positively associated with smoking.

Conclusions
The arterial stiffness has appeared as a possible surrogate marker for stroke in long-term survivors of childhood cancer. Smoking habit might have an additional negative influence on vascular aging in the group of patients after neck radiotherapy.

Is carotid stiffness a possible surrogate for stroke in long-term survivors of childhood cancer after neck radiotherapy?

Radiology and Oncology

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.

Background
The risk for cerebrovascular late effects among childhood cancer survivors is considerable. According to recent studies it is not clear which marker...

	Odds ratio (95%CI)	p value
Smoking	2.765 (0.680–1.238)	0.155
Age at evaluation (years)	1.081 (0.974–1.201)	0.144

Charasteristics and risk factors	Controls	Survivors	P value
Total	26	23
Sex (male (%))	6 (77)	7 (70)	0.40
Smoking (%)	8 (30.8)	7 (30.4)	0.613
Family history (%)	5 (20)	0	0.031
Arterial hypertension (%)	4 (15.4)	6 (26.1)	0.354
Diabetes mellitus	0	0
Age (years)	42.65 ± 5.38	40.22 ± 6.56	0.16
Total cholesterol (mmol/l)	5.7 ± 1.00	5.6 ± 1,01	0.646
Body mass index	25.4 ± 2.98	24.9 ± 1.85	0.595

	Estimate (SE)	p value
Sex	-0.538 (0.471)	0.261
Smoking	0.937 (0.436)	0.031
Age at evaluation (years)	-0.050 (0.034)	0.155
RT (2 groups Size of RT dose (higher than 30 Gy or lower/equal to 30 Gy) )	-0.622 (0.439)	0.165

	Group	N	Mean	Sth. dev.	P value
IMT	0	52	0.546	0.056	0.92
IMT	1	43	0.548	0.132	0.92
Beta stiffness	0	52	6.732	1.437	0.008
Beta stiffness	1	43	8.014	3.035	0.008
Ep	0	52	88.149	20.348	0.008
Ep	1	43	109.767	53.331	0.008
AC	0	52	0.774	0.264	0.034
AC	1	43	0.651	0.293	0.034
AI	0	52	6.722	6.820	0.000
AI	1	43	20.130	12.833	0.000
PWV	0	52	5.733	0.702	0.009
PWV	1	43	6.300	1.334	0.009

	PWV		Wall calcinations and/or plaque

	Linear regression estimate (SE)	p value	Odds ratio (95%CI)	p value
Gender	0.055 (0.448)	0.03	1.121 (0.303–4.145)	0.864
Smoking	0.741 (0.424)	0.088	2.679 (0.681–10.534)	0.158
Arterial hypertension	-0.037 (0.472)	0.938	0.570 (0.143–2.268)	0.425
Age at Dg (years)	0.019 (0.052)	0.718	1.094 (0.936–1.278)	0.258
Age at evaluation (years)	-0.047 (0.032)	0.151	1.078 (0.975–1.192)	0.143
Total cholesterol	0.021 (0.205)	0.920	0.702 (0.381–1.294)	0.257
Body mass index	0.021 (0.118)	0.862	0.926 (0.655–1.309)	0.664
Chemo (yes/no)	0.365 (0.484)	0.455	0.455 (0.100–2.072)	0.309
RT (2 groups Size of radiotherapy dose (higher than 30 Gy or lower/equal to 30 Gy) )	-0.551 (0.431)	0.208	1.680 (0.452–6.249)	0.439

Is carotid stiffness a possible surrogate for stroke in long-term survivors of childhood cancer after neck radiotherapy?

Article Category: Research Article

Published Online: Feb 07, 2018

Page range: 136 - 142

Received: Oct 16, 2017

Accepted: Dec 18, 2017

DOI: https://doi.org/10.2478/raon-2018-0006

© 2018 Lorna Zadravec Zaletel, Matjaz Popit, Marjan Zaletel, published by Sciendo

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.

Figure 1

Multivariate model for wall calcinations and/or plaque

Risk factors in controls and cancer survivors

Multivariate model for carotid pulse-wave velocity (PWV)

T-test for IMT and stiffness parameters

Univariate model for carotid pulse-wave velocity (PWV) and wall calcinations and/or plaque