VASCULAR COMPLICATIONS IN HEAD AND NECK CANCER THERAPY: AN OVERLOOKED BURDEN

Abstract

Background: Head and neck cancer (HNC) therapy has advanced considerably, yet its long-term vascular complications remain an underappreciated determinant of survivorship. This study investigated the incidence, spectrum, and patient-reported burden of vascular complications arising from multimodal HNC treatment.

Methods: A mixed-methods design was employed, integrating quantitative vascular imaging and outcome data with qualitative patient narratives. Quantitative analyses included carotid ultrasonography, CT/MR angiography, and clinical endpoints such as carotid artery stenosis, stroke, carotid blowout syndrome, and venous thrombosis. Qualitative data were obtained through semi-structured interviews, thematically analyzed to contextualize the quantitative findings.

Results: Among survivors, clinically significant carotid artery stenosis (>70%) was detected in a notable proportion, with higher cumulative radiation doses and cisplatin exposure strongly associated with stenotic progression. Carotid blowout syndrome, although infrequent, demonstrated catastrophic outcomes with high morbidity and mortality. Venous complications, particularly jugular thrombosis, were more common in patients undergoing extensive surgery or combined chemoradiotherapy. Longitudinal data indicated a rising incidence of ischemic stroke with extended follow-up, emphasizing the chronic nature of vascular injury. Reconstructive flap analysis revealed compromised microvascular integrity in patients with higher vascular burden. Importantly, quality-of-life assessments and patient interviews highlighted significant declines in physical functioning, autonomy, and psychosocial well-being among those affected by vascular events. Integration of both data strands confirmed a consistent pattern in which treatment intensity correlated with vascular risk, while qualitative accounts underscored the overlooked humanistic dimension of these complications.

Conclusions: Vascular complications represent a critical yet underrecognized outcome of HNC therapy, significantly impacting survival and quality of life. Structured vascular surveillance, preventive strategies, and multidisciplinary survivorship care are urgently needed to address this burden.