Stroke Risk in Head and Neck Cancer: A Meta-analysis of Reconstructed Individual Patient Survival Data

Area of Science:

• Oncology
• Neurology
• Epidemiology

Background:

• Previous research indicates an elevated stroke risk in head and neck cancer (HNC) survivors.
• The specific impact of different treatment modalities, especially radiotherapy, on stroke risk remains less clear.

Purpose of the Study:

• To investigate stroke incidence and risk in HNC patients.
• To analyze how various treatment strategies influence stroke risk in HNC survivors.

Main Methods:

• A comprehensive literature search was conducted across PubMed, Scopus, and Embase.
• Included were primary studies on stroke outcomes in HNC patients (aged 18+) across all cancer subtypes and treatments.
• Random-effects meta-analyses were used to compare stroke risk between HNC patients, healthy controls, and different treatment groups, pooling incidence rates from survival curves.

Main Results:

• The analysis included 15 studies with 2,295,447 patients.
• HNC survivors experienced a 1% annual stroke incidence rate (10% cumulative at 10 years, 15% at 15 years).
• HNC patients showed a 45% higher stroke risk than healthy controls (HR=1.45). Radiotherapy, particularly definitive chemoradiotherapy, significantly increased stroke risk compared to surgery alone or no radiotherapy (HRs ranging from 1.28 to 1.66).

Conclusions:

• HNC patients have a significantly elevated risk of stroke.
• Radiotherapy as a treatment modality is associated with a further increase in stroke risk.
• Enhanced surveillance and tailored preventive measures are crucial for mitigating stroke risk in HNC survivors.