2025 University of Texas MD Anderson Cancer Center Department of Cardiology Grand Rounds: "Vascular sequelae of radiotherapy: The head and neck cancer use-case".

Invited presentation by the UT MDACC Department of Cardiology for Dr. Fuller, delivered live/hybrid at the Cardiology Conferenc eroom, 11th Floor Pickens Tower, 1400 Pressler Blvd, Houston, TX 77030 on 2025-03-25T1200.

Presentation Summary

This talk presents a comprehensive overview of radiation-induced vascular injury in head and neck cancer (HNC) patients, framing the issue as a growing cardio-oncologic concern and an opportunity for prospective intervention trials.

Key Themes & Structure:

1. Clinical Context: Radiotherapy in HNC

• Advances in IMRT and proton therapy have improved parotid and normal tissue sparing.
• However, radiation-associated vasculopathy—especially carotid artery stenosis (CAS) and cerebrovascular events (CVEs)—is an underappreciated late toxicity.
• Imaging data show progressive tissue and vascular damage years after radiotherapy, even with modern techniques.

2. Emerging Epidemiologic Signal

• Retrospective and population-level data (JCO, JAMA Otolaryngology) show an increased long-term risk of stroke and vascular events post-RT.
• CAS incidence rises significantly after neck irradiation, with differences observed between nasopharyngeal carcinoma (NPC) and non-NPC patients.

3. Mechanistic Insights

• Preclinical murine models reveal chronic endothelial dysfunction, collagen deposition, and vascular stiffening post-irradiation.
• Long-term pravastatin therapy (started pre-RT) reduces or abolishes vascular injury, suggesting a prophylactic role for statins in radiation vasculopathy.