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

Although previous studies suggest an increased stroke risk in head and neck cancer (HNC) survivors, the risk with various treatment modalities, including radiotherapy, is less certain. This study investigates stroke incidence and risk in HNC patients, including how different treatments influence stroke risk.

A literature search of PubMed, Scopus, and Embase was conducted.

We included all primary studies assessing stroke as an outcome in HNC patients aged 18 and older, regardless of cancer subtype or treatment modality. Incidence rates were pooled by reconstructing individual patient time-to-event data from survival curves. Random-effects meta-analyses were employed to compare stroke risk between HNC patients, healthy controls, and treatment groups.

In total, 15 studies (N = 2,295,447 patients) were included in the analyses. Among surviving HNC patients, stroke occurred at a rate of 1% per year (10% at 10 years and 15% at 15 years cumulatively). Meta-analyses showed that HNC patients had a significantly higher stroke risk compared to healthy controls (hazard ratio [HR] = 1.45; 95% CI: 1.27-1.65; I²: 20%). Among HNC patients, radiotherapy alone increased stroke risk compared to surgery alone (HR = 1.66; 95% CI: 1.35-2.03; I²: 0%). Patients who received any form of radiotherapy had higher stroke risk compared to those without (HR = 1.47; 95% CI: 1.29-1.68; I²: 60%). Patients with definitive chemoradiotherapy had heightened stroke risk compared to patients who received definitive surgery (HR = 1.28; 95% CI: 1.09-1.49; I²: 86%).

Patients with HNC face an elevated stroke incidence and risk, especially those treated with radiotherapy. This underscores the need for surveillance and tailored preventive strategies to reduce stroke risk in this vulnerable population.