Management of intractable epistaxis in patients who received radiation therapy for nasopharyngeal carcinoma

Abstract

To report clinical manifestations, bleeding point localization, and outcomes of management in 16 patients with 16 instances of intractable epistaxis after radiation therapy for nasopharyngeal carcinoma. Retrospective chart review of 16 patients with nasopharyngeal carcinoma (mean age 52.06 ± 14.37 years) with 16 instances of intractable epistaxis during the past 5 years, whose diagnosis was confirmed by angiography (n = 10) or MRI/CT imaging studies and clinical manifestations (n = 6). The mean radiation dose to the affected carotid artery was 101.37 ± 34.85 Gy. Bleeding points were detected in the internal carotid artery (n = 8) or external carotid artery (n = 8). Detachable balloons were used in one affected artery for vascular occlusion; six were treated using an absorbable gelatin sponge (n = 4) or microcoils (diameter 1 mm) (n = 2). Endovascular embolization was successful in seven radiation carotid blowout syndromes with cessation of hemorrhage. One patient underwent external carotid artery ligation and one patient recovered without treatment. The clinical follow-up was 3 months. Therapeutic endovascular embolization of intractable epistaxis is both efficient and safe. It should be considered as the primary treatment modality in intractable epistaxis of nasopharyngeal carcinoma.

<p>Endovascular Management of Intractable Nasopharyngeal Hemorrhage in Patients Irradiated for Nasopharyngeal Carcinoma: A Twelve-Year Experience</p>

“…15 However, He et al reported that concerning stent erosion and infection because of local inflamed and necrotic tissue, as well as a lack of antiplatelet preparation, the main trunk occlusion should be thought as the preferred treatment toward, if feasible. 7 In our experience, we agree with He's opinion because most of the lesion vessels are significantly poor and the coils are the common embolized agents that can be used in emergent situations. But in some situations where the patients' hemodynamics are stable and the lesion vessels are not so much poor, the covered stents can be considered to be used.…”

“…5 Endovascular treatment has been recommended as the first-line treatment modality by some doctors because angiography can detect the bleeding vessels quickly and accurately and endovascular embolization has a high success rate, especially for patients with a ruptured pseudoaneurysm in the internal carotid which is a significant catastrophic condition. 7,[13][14][15] In our study, twenty-three patients (95.8%) were successfully treated by one-time or two-time endovascular embolization, which showed a great efficacy of endovascular treatment of nasopharyngeal hemorrhage after radiotherapy for NPC. One patient died of abrupt massive hemorrhage (case 1) and three patients had re-bleeding (case 2, case 4, case 5).…”

“…Meanwhile, the growth of tumor and radiotherapy result in the extensive development of the collateral vessels in the nasopharynx. 7 Therefore, the patients with NPC after radiotherapy are likely to appear intractable hemorrhage; Secondly, the glossopharyngeal nerve is located in the radiotherapy field of NPC. After radiotherapy, the glossopharyngeal nerve is damaged, resulting in a decrease of pharyngeal sensation and atrophy of muscles.…”

A model to predict the risk of lethal nasopharyngeal necrosis after re-irradiation with intensity-modulated radiotherapy in nasopharyngeal carcinoma patients

“…First, quick and effective measures are very important for hemorrhage rescue, but treatments of massive nasopharyngeal bleeding varied considering expense, distance, and clinical medical condition. Massive nasopharyngeal bleeding involving the internal maxillary artery could be rescued with effective treatment, such as hemostasis by gelatin sponge compression, nasopharyngeal packing, artery ligation, and other surgical measures [ 32 ]. However, carotid artery rupture is a common result of LNN, which results in a high mortality [ 15 ].…”

Carotid blowout syndrome after nasopharyngeal carcinoma radiotherapy: successful treatment by internal carotid artery occlusion after stent implantation failure

“…More recently, endovascular treatment has provided an effective way to control the bleeding associated with carotid blowout syndrome. In previous works, some researchers have suggested that stent placement is safe and feasible for this disease (Hakime et al 2013 ; Farivar et al 2014 ), and some argued that endovascular embolization provides both safe and effective management (He et al 2013 ). Additionally, some researchers have found that there was no significant difference in the technical and hemostatic outcomes of stent placement and endovascular embolization (Chang et al 2008 ).…”