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Carotid artery (CA) involvement in head and neck cancer (HNC) has a low incidence, occurring in 2–7% cases of advanced HNCs. Clinical scenarios can be various, with the CA being displaced, surrounded by the mass, or with its wall invaded in different degrees of depth. Magnetic resonance has proved to be a reliable tool in predicting CA invasion, although standardization in terms of radiological criteria that define CA involvement are lacking. Management of CA involvement has been historically debated in HNC, primarily due to the high risk of treatment-related complications, which are not counterbalanced by reasonable control of the disease. Even if indications have been profoundly changed over the years, with some data supporting the feasibility of common and internal carotid artery (CCA/ICA) unilateral resection in accurately selected patients with skull base cancer (SBC) or HNC, debate arises from the potential severe morbidity of resection and reconstruction, neurological complications after vessel removal, and dismal prognosis in advanced-stage malignancies. While CA resection-sparing alternatives exist, these are still not devoid of risks. Thus, awareness of the existing different options is critical, and accurate evaluation of surgical and non-surgical alternatives is mandatory. In this overtly complex setting, clinicians should focus on a few specific questions: is CCA/ICA resection feasible? Is vessel reconstruction feasible? How accurately can we predict tolerance to CA resection? Is the risk/benefit ratio acceptable? Are there valuable alternatives? In this review, much attention is paid to analyze the evolution over the years of the definition of CCA/ICA involvement, the different impact of surgical and nonsurgical approaches, and prognostic outcomes. Ultimately, multidisciplinary management, which can guarantee a comprehensive and thoughtful approach, is essential to achieve an optimized patient-centered approach and to pursue favorable oncologic outcomes while not exposing the patient to unreasonable morbidity.

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Managing the Internal Carotid Artery in Head and Neck Cancer: Where Are We?

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  • 出版模式：

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  • 发表日期：

    2025年

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  • Alessandra Ruaro,
  • Stefano Taboni,
  • Marco Ferrari,
  • Piero Nicolai

摘要

Carotid artery (CA) involvement in head and neck cancer (HNC) has a low incidence, occurring in 2–7% cases of advanced HNCs. Clinical scenarios can be various, with the CA being displaced, surrounded by the mass, or with its wall invaded in different degrees of depth. Magnetic resonance has proved to be a reliable tool in predicting CA invasion, although standardization in terms of radiological criteria that define CA involvement are lacking. Management of CA involvement has been historically debated in HNC, primarily due to the high risk of treatment-related complications, which are not counterbalanced by reasonable control of the disease. Even if indications have been profoundly changed over the years, with some data supporting the feasibility of common and internal carotid artery (CCA/ICA) unilateral resection in accurately selected patients with skull base cancer (SBC) or HNC, debate arises from the potential severe morbidity of resection and reconstruction, neurological complications after vessel removal, and dismal prognosis in advanced-stage malignancies. While CA resection-sparing alternatives exist, these are still not devoid of risks. Thus, awareness of the existing different options is critical, and accurate evaluation of surgical and non-surgical alternatives is mandatory. In this overtly complex setting, clinicians should focus on a few specific questions: is CCA/ICA resection feasible? Is vessel reconstruction feasible? How accurately can we predict tolerance to CA resection? Is the risk/benefit ratio acceptable? Are there valuable alternatives? In this review, much attention is paid to analyze the evolution over the years of the definition of CCA/ICA involvement, the different impact of surgical and nonsurgical approaches, and prognostic outcomes. Ultimately, multidisciplinary management, which can guarantee a comprehensive and thoughtful approach, is essential to achieve an optimized patient-centered approach and to pursue favorable oncologic outcomes while not exposing the patient to unreasonable morbidity.