With the rapidly increasing prevalence of oropharyngeal squamous cell carcinoma (OPSCC), largely driven by the human papillomavirus (HPV) epidemic, and with relative equipoise between radiation-based and surgery-based treatment protocols, there has been renewed interest in describing differences in functional outcomes between the 2 treatment modalities. Radiation is theoretically related to stroke risk due to carotid artery intimal injury, which could lead to the development of atherosclerosis. Both carotid artery stenosis and carotid intima -medial thickness have been shown to be associated with radiation therapy providing a biologic basis for the findings. A retrospective population-based cohort study of veterans with OPSCC authored by Sun et al reported a 12.5% imputed stroke risk within 10 years after treatment. The major finding of this study is that there was an observed 23% relative risk reduction of stroke in patients treated with definitive surgery as compared with those treated with definitive radiotherapy. Although there were notable differences between the groups at baseline, in particular higher T- and N-stage as well as worse ECOG performance status and Charlson Comorbidity Index in the nonsurgical group, the authors conducted propensity score–based analyses to account for these imbalances. Interestingly, there was no increase in stroke risk among surgical patients treated with adjuvant radiation as compared with those treated with surgery alone. (Other population-based studies have observed the same.)
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