Abstract 19952: HPV Status and the Risk of Cerebrovascular Events Following Radiotherapy for Head and Neck Cancer
Background: Radiotherapy (RT) is a standard primary treatment for head and neck cancer (HNCA); however, RT for HNCA is associated with an increased risk of cerebrovascular events (CVE, stroke or transient ischemic attack (TIA)). Human papilloma virus (HPV) is present in two-thirds of primary HNCAs and is associated with an increase in cardiovascular events in women. Whether HPV infection confers an increased risk of CVEs after neck RT is unclear.
Methods: From an institutional database we identified all consecutive subjects with HNCA tested for HPV and who were treated with neck RT between 2002 and 2012. Data collection, including cardiovascular and cancer-specific variables and event adjudication were performed by independent and blinded groups. The outcome of interest was a composite of ischemic stroke and TIA. Association between HPV and CVEs was determined using Cox proportional hazard model. Comparisons of event rates were performed by the log-rank test.
Results: There were 322 patients tested for HPV who received RT for HNCA (59±12 years, 75% male, 10% DM, 45% HTN, 72% active or prior smokers, mean LDL 104±34 mg/dl, 89% treated with chemotherapy and 42% with neck dissection). HPV was positive in 190 (59%) and HPV-16 was the predominant sub-type. Those with HPV were more likely to be male and have oropharyngeal carcinoma. The median follow-up time from RT was 3.9 years (range 1-14 years) and there were 18 ischemic strokes and 5 TIAs (event rate of 5.9% per year). The event rate was 5.0% per year in HPV+ patients compared to 1.1% in HPV- (p=0.009; see figure). In a multi-variable model, HPV status remained associated with an increased risk for a CVE (HR: 3.2, CI 1.2-8.7; p=0.03).
Conclusion: These data show for the first time that HPV status is associated with an increase in stroke and TIA after RT for HNCA. Recognition of this high-risk group may help clinicians caring for the increased number of survivors of HNCA.
Author Disclosures: D. Addison: None. S.B. Seidelmann: None. S. Janjua: None. H. Emami: None. P. Staziaki: None. B. Szilveszter: None. T. Hallett: None. M. Lu: None. J. Romero: None. A. Chan: None. L. Wirth: None. U. Hoffmann: None. T. Neilan: None.
- © 2016 by American Heart Association, Inc.