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      Total plaque score helps to determine follow-up strategy for carotid artery stenosis progression in head and neck cancer patients after radiation therapy

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          Abstract

          Background

          To identify predictors of carotid artery stenosis (CAS) progression in head and neck cancer (HNC) patients after radiation therapy (RT).

          Methods

          We included 217 stroke-naïve HNC patients with mild carotid artery stenosis after RT in our hospital. These patients underwent annual carotid duplex ultrasound (CDU) studies to monitor CAS progression. CAS progression was defined as the presence of ≥50% stenosis of the internal/common carotid artery on follow-up CDU. We recorded total plaque score (TPS) and determined the cut-off TPS to predict CAS progression. We categorized patients into high (HP) and low plaque (LP) score groups based on their TPS at enrolment. We analyzed the cumulative events of CAS progression in the two groups.

          Results

          The TPS of the CDU study at enrolment was a significant predictor for CAS progression (adjusted odds ratio [aOR] = 1.69, p = 0.002). The cut-off TPS was 7 (area under the curve: 0.800), and a TPS ≥ 7 strongly predicted upcoming CAS progression (aOR = 41.106, p = 0.002). The HP group had a higher risk of CAS progression during follow-up (adjusted hazard ratio = 6.15; 95% confident interval: 2.29–16.53) in multivariable Cox analysis, and also a higher trend of upcoming ischemic stroke (HP vs. LP: 8.3% vs. 2.2%, p = 0.09).

          Conclusions

          HNC patients with a TPS ≥ 7 in any CDU study after RT are susceptible to CAS progression and should receive close monitoring within the following 2 years.

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          Most cited references32

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          Guidelines for the prevention of stroke in patients with stroke and transient ischemic attack: a guideline for healthcare professionals from the American Heart Association/American Stroke Association.

          The aim of this updated guideline is to provide comprehensive and timely evidence-based recommendations on the prevention of future stroke among survivors of ischemic stroke or transient ischemic attack. The guideline is addressed to all clinicians who manage secondary prevention for these patients. Evidence-based recommendations are provided for control of risk factors, intervention for vascular obstruction, antithrombotic therapy for cardioembolism, and antiplatelet therapy for noncardioembolic stroke. Recommendations are also provided for the prevention of recurrent stroke in a variety of specific circumstances, including aortic arch atherosclerosis, arterial dissection, patent foramen ovale, hyperhomocysteinemia, hypercoagulable states, antiphospholipid antibody syndrome, sickle cell disease, cerebral venous sinus thrombosis, and pregnancy. Special sections address use of antithrombotic and anticoagulation therapy after an intracranial hemorrhage and implementation of guidelines. © 2014 American Heart Association, Inc.
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            Nasopharyngeal carcinoma.

            Epidemiological trends during the past decade suggest that although incidence of nasopharyngeal carcinoma is gradually declining, even in endemic regions, mortality from the disease has fallen substantially. This finding is probably a result of a combination of lifestyle modification, population screening coupled with better imaging, advances in radiotherapy, and effective systemic agents. In particular, intensity-modulated radiotherapy has driven the improvement in tumour control and reduction in toxic effects in survivors. Clinical use of Epstein-Barr virus (EBV) as a surrogate biomarker in nasopharyngeal carcinoma continues to increase, with quantitative assessment of circulating EBV DNA used for population screening, prognostication, and disease surveillance. Randomised trials are investigating the role of EBV DNA in stratification of patients for treatment intensification and deintensification. Among the exciting developments in nasopharyngeal carcinoma, vascular endothelial growth factor inhibition and novel immunotherapies targeted at immune checkpoint and EBV-specific tumour antigens offer promising alternatives to patients with metastatic disease.
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              Epidemiology of head and neck cancer.

              This article discusses risk factors, incidence trends, and prognostic considerations for head and neck cancer (HNC). The primary causes of HNC are tobacco and alcohol use, and human papillomavirus (HPV). Tobacco-related HNC incidence rates are decreasing in countries where tobacco use has declined. HPV-HNC, which occurs primarily in the oropharynx and is associated with sexual behaviors, has been increasing over the past several decades, among white men in particular. The prognosis for HNC overall has improved slightly since the 1990s, and is influenced by site, stage, and HPV status. Prognosis for HPV-HNC is significantly better than for HPV-negative disease.
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                Author and article information

                Contributors
                Role: ConceptualizationRole: Data curationRole: Formal analysisRole: Funding acquisitionRole: InvestigationRole: MethodologyRole: Writing – original draftRole: Writing – review & editing
                Role: ConceptualizationRole: Data curationRole: Formal analysisRole: InvestigationRole: MethodologyRole: Writing – original draftRole: Writing – review & editing
                Role: ConceptualizationRole: Data curationRole: MethodologyRole: Writing – review & editing
                Role: Data curationRole: Methodology
                Role: Data curationRole: Supervision
                Role: InvestigationRole: Methodology
                Role: Data curationRole: Methodology
                Role: Data curationRole: Investigation
                Role: Data curationRole: Methodology
                Role: Data curationRole: Resources
                Role: Data curation
                Role: ConceptualizationRole: Data curationRole: Formal analysisRole: Funding acquisitionRole: InvestigationRole: MethodologyRole: Project administrationRole: Writing – review & editing
                Role: Editor
                Journal
                PLoS One
                PLoS One
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                12 February 2021
                2021
                : 16
                : 2
                : e0246684
                Affiliations
                [1 ] Stroke Center and Department of Neurology, Chang Gung Memorial Hospital, Linkou Medical Center and College of Medicine, Chang Gung University, Taoyuan, Taiwan
                [2 ] Department of Radiation Oncology, Proton and Radiation Therapy Center, Chang Gung Medical Foundation, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
                [3 ] Taipei Chang Gung Head & Neck Oncology Group, Chang Gung Memorial Hospital Linkou Medical Center, Taoyuan, Taiwan
                [4 ] Department of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
                [5 ] Department of Laboratory Medicine, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan
                [6 ] Department of Medical Biotechnology and Laboratory Science, Chang Gung University, Taoyuan, Taiwan
                [7 ] Particle Physics and Beam Delivery Core Laboratory of Institute for Radiological Research, Chang Gung University/Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan
                [8 ] Chang Gung Medical Education Research Centre, Taoyuan, Taiwan
                IPATIMUP/i3S, PORTUGAL
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                ‡ These authors contributed equally and are co-first authors.

                Article
                PONE-D-20-34151
                10.1371/journal.pone.0246684
                7880459
                33577590
                9d55f021-0cd3-4af5-a105-33823773d7d8
                © 2021 Liu et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 30 October 2020
                : 22 January 2021
                Page count
                Figures: 4, Tables: 2, Pages: 12
                Funding
                Funded by: Chang Gung Memorial Hospital
                Award ID: CMRPG381503, CMRPG3C0763, CMRPG3G0261, and BMRPF99
                Award Recipient :
                Funded by: funder-id http://dx.doi.org/10.13039/100007225, Ministry of Science and Technology;
                Award ID: 106-2511-S-182A-002-MY2, 108-2314-B-182A-050-MY3, NMRPG3G6411-2, and NMRPG3J6131-3
                Award Recipient :
                Funding was provided by Chang Gung Memorial Hospital (grant number: CMRPG381503, CMRPG3C0763, CMRPG3G0261, BMRPF99) and the Ministry of Science and Technology (grant numbers: 106-2511-S-182A-002 -MY2, 108-2314-B-182A-050-MY3, NMRPG3G6411-2, and NMRPG3J6131-3).
                Categories
                Research Article
                Medicine and Health Sciences
                Clinical Medicine
                Signs and Symptoms
                Stenosis
                Biology and Life Sciences
                Anatomy
                Cardiovascular Anatomy
                Blood Vessels
                Arteries
                Carotid Arteries
                Medicine and Health Sciences
                Anatomy
                Cardiovascular Anatomy
                Blood Vessels
                Arteries
                Carotid Arteries
                Medicine and Health Sciences
                Vascular Medicine
                Atherosclerosis
                Medicine and Health Sciences
                Oncology
                Cancer Treatment
                Radiation Therapy
                Medicine and Health Sciences
                Clinical Medicine
                Clinical Oncology
                Radiation Therapy
                Medicine and Health Sciences
                Oncology
                Clinical Oncology
                Radiation Therapy
                Medicine and Health Sciences
                Oncology
                Cancers and Neoplasms
                Carcinoma
                Nasopharyngeal Carcinoma
                Medicine and Health Sciences
                Pharmaceutics
                Drug Therapy
                Antiplatelet Therapy
                Medicine and Health Sciences
                Oncology
                Cancers and Neoplasms
                Head and Neck Cancers
                Medicine and Health Sciences
                Epidemiology
                Medical Risk Factors
                Cancer Risk Factors
                Medicine and Health Sciences
                Oncology
                Cancer Risk Factors
                Custom metadata
                Data cannot be completely shared publicly because of the regulations from our Ethics Committee. Data inquiries can be sent to the Chang Gung Medical Foundation Biobank (Email: tissuebankcgmh@ 123456gmail.com ). The relevant data which could be provided are within the manuscript and its Supporting information files.

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