Transarterial Embolization for Bleeding in Patients with Head and Neck Cancer: Who Benefits?

Abstract

Objectives/Hypothesis: The present study aimed to investigate the efficacy of transarterial embolization (TAE) for bleeding in patients with head and neck cancer (HNC) and to evaluate the prognostic factors after TAE.Study design: Outcome study.Methods: This retrospective study included 31 consecutive patients (27 men and 4 women; median age, 61 years) who presented uncontrollable hemorrhage associated with HNC and underwent emergency TAE at our institution during a 10-year period (January 2011-December 2020). This corresponded to 40 TAE procedures, including 27 cases with an unstable status (circulatory and/or respiratory insufficiency) and 10 cases with carotid blowout syndrome. The technical success rate and adverse events were analyzed on a per-procedure basis. The rebleeding and overall survival (OS) rates were analyzed on a per-patient basis, and the factors related to OS were evaluated.Results: The technical success rate was 100%. As an adverse event, cerebral infarction was found in three cases with carotid blowout syndrome. The rebleeding rate at 30 days after TAE and in the follow-up period (range, 9-3,004 days) was 17.2% and 35.5%, respectively. The median survival time was 263 days (95% confidence interval: 124.0-402.0 days). In the log-rank test, complete remission (CR) of the primary cancer at the time of the first TAE was identified as a significant influencing factor of survival.Conclusion: TAE is effective for the treatment of hemorrhage associated with HNC even in patients with an unstable status. Patients with CR can gain a long life span.

Management of postradiation late hemorrhage following treatment for HPV‐positive oropharyngeal squamous cell carcinoma

“…Further, advancements in embolization make it a relatively safe procedure when performed by experienced proceduralists. 15,16,18 All patients in this cohort presenting with oropharyngeal hemorrhage had received prior RT. The findings of soft tissue necrosis may be related to long-term tissue damage from prior radiation, suggesting the treatment weakened tissues to an extent that they were vulnerable to friability and hemorrhage.…”

“…Prophylactic embolization of the commonly involved blood vessels, specifically the external carotid artery, lingual artery, and facial artery still may be considered, but may not provide permanent results. Further, advancements in embolization make it a relatively safe procedure when performed by experienced proceduralists 15,16,18 …”

“…Acute hemorrhage is an uncommon but potentially deadly complication for patients with head and neck cancer, especially in patients receiving RT 7–14 . Previous reports have focused on hemorrhage following RT in all head and neck subsite without isolating HPV‐positive malignancies 9–11,15–19 . In this article, we focus specifically on patients with previously treated HPV‐positive OPSCC given (1) the increasing prevalence and survival of this population and (2) the critical role RT plays in its treatment.…”

“…[7][8][9][10][11][12][13][14] Previous reports have focused on hemorrhage following RT in all head and neck subsite without isolating HPV-positive malignancies. [9][10][11][15][16][17][18][19] In this article, we focus specifically on patients with previously treated HPV-positive OPSCC given (1) the increasing prevalence and survival of this population and (2) the critical role RT plays in its treatment. Here, we detail patient characteristics and cancer treatments leading to hemorrhagic events and include the acute interventions used in these life-threatening situations to better characterize this patient population.…”

The efficacy and safety of 125I brachytherapy combined with pre-operative transarterial chemoembolization in patients with locally advanced head and neck cancer

“…Therefore, traditional hemostatic methods, such as local compression, nasal packing, bandaging and suture, and drug hemostasis, are often ineffective. The increase in blood loss may lead to asphyxia and shock, which is very difficult to deal with clinically ( 12 , 13 ). An alternative is presented by endovascular approaches with selective arterial embolization, which has a minimal impact on surrounding tissues.…”