Chemoradiotherapy-related carotid artery inflammation in head and neck cancer patients quantified by [18F]FDG PET/CT

Xuguang Chen, Yiran Zheng, Curtis Tatsuoka, Raymond F. Muzic, Christian C. Okoye, James K. O'Donnell, David Zidar, Norbert Avril, Guilherme H. Oliveira, Hongyan Liu, Jessica Bucher, Mitchell Machtay, Min Yao, Jennifer A. Dorth

Research output: Contribution to journalArticlepeer-review

6 Scopus citations


Objectives: Radiotherapy (RT) is associated with an increased risk of cardiovascular disease (CVD), but little is known about the mechanism for vascular injury and methods for early detection. Materials and methods: We conducted a prospective, pilot study of carotid artery inflammation using 18F-labeled 2-fluoro-2-deoxy-D-glucose ([18F]FDG) PET/CT imaging pre- and 3 months post-RT in head-and-neck cancer (HNC) patients. [18F]FDG uptake by the carotid arteries was measured by the maximum and mean target to background ratio (TBRMAX, TBRMEAN) and the mean partial volume corrected standardized uptake value (pvcSUVMEAN). Results: Of the 22 patients who completed both pre and post-RT scans, the majority (82%) had stage III or stage IV disease and received concurrent chemotherapy. TBRMAX, TBRMEAN, and pvcSUVMEAN were all significantly higher 3 months after RT versus before RT with mean difference values (95% CI; p-value) of 0.17 (0.1–0.25; 0.0001), 0.19 (0.12–0.25; 0.0001), and 0.31 g/ml (0.12–0.5; 0.002), respectively. Fifteen patients (68%) had HPV-positive tumors, which were associated with lower pre-RT [18F]FDG signal, but a greater increase in TBRMAX (19% vs 5%), TBRMEAN (21% vs 11%) and pvcSUVMEAN (20% increase vs 3% decrease), compared to HPV negativity. Conclusion: There is a significant increase in carotid artery inflammation in HNC patients due to CRT that amounts to a degree that has previously been associated with higher risk for future CVD events. The subset of patients with HPV-positive tumors experienced the greatest increases in vascular inflammation due to CRT. Carotid [18F]FDG uptake may be an early biomarker of RT-related vascular injury.

Original languageEnglish (US)
Pages (from-to)101-106
Number of pages6
JournalOral Oncology
StatePublished - Jun 2019

All Science Journal Classification (ASJC) codes

  • Oral Surgery
  • Oncology
  • Cancer Research


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