Carotid blowout syndrome after reirradiation for head and neck malignancies: a comprehensive systematic review for a pragmatic multidisciplinary approach

Alterio, Daniela; Turturici, Irene; Volpe, Stefania; Ferrari, Annamaria; Russell-Edu, Samuel William; Vischioni, Barbara; Mardighian, Dikran; Preda, Lorenzo; Gandini, Sara; Marvaso, Giulia; Augugliaro, Matteo; Durante, Stefano; Arculeo, S.; Patti, Filippo; Boccuzzi, Dario; Casbarra, Alessia; Starzyńska, Anna; Santoni, Riccardo; Jereczek‐Fossa, Barbara Alicja

doi:10.1016/j.critrevonc.2020.103088

Cited by 20 publications

(25 citation statements)

References 52 publications

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“…The findings of the present study concur with those of previous studies, as all nine tumors that caused hemorrhage involved the carotid > 180 degrees and larger GTV than non-hemorrhagic tumors. The Hypofractionated Treatment Effects in the Clinic (HyTEC) group found that a maximum dose to the major vessels of 20–30 Gy in 5 fractions was generally low risk, but risk increased quickly > 30 Gy to a tolerance dose of 45.7 Gy 15 , 22 , 30 . The other factors that reduced the rate of CBOS were alternate day treatment rather than daily treatment, not treating patients with skin invasion, necrosis, or infection, and avoiding postoperative treatment 15 .…”

Section: Discussionmentioning

confidence: 99%

Reirradiation for local recurrence of oral, pharyngeal, and laryngeal cancers: a multi-institutional study

Yamazaki

Suzuki

Aibe

et al. 2023

Sci Rep

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This study aimed to examine the efficacy and toxicity of reirradiation in patients with locally recurrent oral, pharyngeal, and laryngeal cancers. We conducted a retrospective, multi-institutional analysis of 129 patients with previously irradiated cancer. The most frequent primary sites were the nasopharynx (43.4%), oral cavity (24.8%), and oropharynx (18.6%). With a median follow-up duration of 10.6 months, the median overall survival was 14.4 months and the 2-year overall survival rate was 40.6%. For each primary site, the 2-year overall survival rates were 32.1%, 34.6%, 30%, 60.8%, and 5.7% for the hypopharynx, oral cavity, larynx, nasopharynx, and oropharynx, respectively. Prognostic factors for overall survival were primary site (nasopharynx versus other sites) and gross tumor volume (GTV) (≤ 25 cm3 versus > 25 cm3). The 2-year local control rate was 41.2%. Twenty-four patients (18.6%) presented with grade ≥ 3 toxicities, including nine with hemorrhages that led to grade 5 toxicities in seven patients. All nine tumors that caused hemorrhage showed tumor encasement of the carotid ≥ 180 degrees and eight of nine tumors had larger GTV > 25 cm3. Reirradiation is a feasible treatment option for small local recurrence of oral, pharyngeal, and laryngeal cancers, with the requirement of a strict eligibility assessment for large tumors with carotid encasement.

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Section: Discussionmentioning

confidence: 99%

Reirradiation for local recurrence of oral, pharyngeal, and laryngeal cancers: a multi-institutional study

Yamazaki

Suzuki

Aibe

et al. 2023

Sci Rep

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“…The hemorrhage was probably due to carotid blowout syndrome (CBS), of which the incidence was 3% to 4.5% in all postoperative patients and 4.5% to 21.1% in patients who received reirradiation[ 28 ]. The mortality of CBS was as high as 75%[ 29 ]. Two of the four patients received surgery and second radiotherapy, which were both independent risk factors for CBS[ 30 ].…”

Section: Discussionmentioning

confidence: 99%

Concurrent chemoradiotherapy using gemcitabine and nedaplatin in recurrent or locally advanced head and neck squamous cell carcinoma

Huo¹,

Jin²,

Zhuo³

et al. 2022

WJCC

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BACKGROUND Patients with recurrent or locally advanced head and neck squamous cell carcinoma (HNSCC) typically have limited treatment options and poor prognosis. AIM To evaluate the efficacy and safety of two drugs with potent radio-sensitization properties including gemcitabine and nedaplatin as concurrent chemoradiotherapy regimens in treating HNSCC. METHODS This single-arm prospective study enrolled patients with HNSCC to receive gemcitabine on days 1 and 8 and nedaplatin on days 1 to 3 for 21 days. Intensity-modulated radiation therapy with a conventional fraction was delivered 5 days per week. Objective response rate (ORR), disease control rate, and toxicity were observed as primary endpoints. Overall survival (OS) and progression free survival were recorded and analyzed as secondary endpoints. RESULTS A total of 24 patients with HNSCC were enrolled. During the median 22.4-mo follow-up, both ORR and disease control rate were 100%. The one-year OS was 75%, and one-year progression-free survival (PFS) was 66.7% (median PFS was 15.1 mo). Recurrent HNSCC patients had a poorer prognosis than the treatment-naïve patients, and patients who achieved complete response had better survival than those in the PR group (all P < 0.05). The most common grade 1-4 (100%) or grade 3-4 toxicities (75%) were hematological, and the most common grade 3-4 non-hematological toxicity was mucositis in 17 (71%) patients. CONCLUSION Gemcitabine plus nedaplatin with concurrent chemoradiotherapy is a therapeutic option for HNSCC with predictable tolerability. Considering the high adverse event rate, the optimized dose and schedule must be further explored.

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“…Patients who underwent BCS without any RT were excluded. We also excluded patients with unknown values of crucial treatment variables, including breast cancer subtype (i.e., estrogen receptor (ER), progesterone receptor [10] , and HER2 status were all unknown, or both ER and PR status were unknown), type of surgery, whether lymph nodes were examined during surgery, margin status at surgery, ypT stage, receipt of RT, and receipt of endocrine therapy (ET). Patients were also excluded if they received RT as neoadjuvant therapy, or if they received RT to a site other than the breast, CW, or regional lymph nodes.…”

Section: Methodsmentioning

confidence: 99%

Regional nodal irradiation (RNI) in breast cancer patients with residual isolated tumor cells or micrometastatic nodal disease after neoadjuvant chemotherapy

Kim¹,

Karp²,

Gerber³

2023

Clinical and Translational Radiation Oncology

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Carotid blowout syndrome after reirradiation for head and neck malignancies: a comprehensive systematic review for a pragmatic multidisciplinary approach

Cited by 20 publications

References 52 publications

Reirradiation for local recurrence of oral, pharyngeal, and laryngeal cancers: a multi-institutional study

Reirradiation for local recurrence of oral, pharyngeal, and laryngeal cancers: a multi-institutional study

Concurrent chemoradiotherapy using gemcitabine and nedaplatin in recurrent or locally advanced head and neck squamous cell carcinoma

Regional nodal irradiation (RNI) in breast cancer patients with residual isolated tumor cells or micrometastatic nodal disease after neoadjuvant chemotherapy

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