Abstract
Radiation therapy and stroke risk in head and neck cancer survivors: a contemporary cohort study using seer-medicare data
Annals of epidemiology, Vol.122(October 2026), 110218
09/15/2026
DOI: 10.1016/j.annepidem.2026.110218
Abstract
Purpose
Head and neck cancer survivors face an elevated risk of stroke, potentially worsened by radiation therapy. However, prior studies reflect outdated treatment eras. We examined the association between modern-era radiation therapy and stroke risk using a large national cohort.
Methods
A retrospective cohort study using SEER-Medicare data (2000–2019) identified patients aged ≥66 years with newly diagnosed head and neck cancer. Patients were categorized into treatment groups: definitive radiation therapy, definitive surgery, and surgery plus radiation therapy. Time-varying Cox models adjusted for relevant covariates were used. The primary outcome was any stroke; secondary outcomes included ischemic stroke, hemorrhagic stroke, and ischemic stroke or carotid revascularization.
Results
Among 69,516 patients, definitive radiation therapy (37% of patients) was associated with increased risk of ischemic stroke (HR = 1.15 (95%CI: 1.03–1.29)) and ischemic stroke or carotid revascularization (HR = 1.18 (95%CI: 1.07–1.31)) compared to definitive surgery (22% of patients), whereas the risk of the combined outcome (HR = 1.11 (95%CI: 1.00–1.23)) and the risk of hemorrhagic stroke (HR = 0.91 (95%CI: 0.69–1.21)) were not significantly elevated. Subgroup analysis showed elevated risk among larynx and floor of mouth cancers for definitive radiation therapy compared to definitive surgery. Compared with definitive surgery, no increased risk of ischemic stroke was observed in the surgery plus radiation therapy group (HR = 0.99 (95%CI: 0.89–1.10)) or in the group that received neither surgery nor radiation (HR = 1.06 (95%CI: 0.92–1.22)).
Conclusions
Modern-era radiation therapy remains associated with ischemic stroke. Vascular surveillance may benefit head and neck cancer survivors.
Details
- Title: Subtitle
- Radiation therapy and stroke risk in head and neck cancer survivors: a contemporary cohort study using seer-medicare data
- Creators
- Khaled Algrni - Department of Epidemiology, University of Iowa, IA, USABradley McDowell - University of IowaRyan Carnahan - University of IowaKnute D. Carter - University of IowaCarryn Anderson - University of IowaJames Torner - University of IowaElizabeth Chrischilles - University of Iowa
- Resource Type
- Abstract
- Publication Details
- Annals of epidemiology, Vol.122(October 2026), 110218
- DOI
- 10.1016/j.annepidem.2026.110218
- ISSN
- 1047-2797
- Publisher
- Elsevier Inc
- Language
- English
- Electronic publication date
- 09/15/2026
- Academic Unit
- Neurology; Pharmacy; Epidemiology; Biostatistics; Surgery; Radiation Oncology; Nursing; Injury Prevention Research Center; Neurosurgery; Holden Comprehensive Cancer Center
- Record Identifier
- 9985230924702771
Metrics
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