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.
Highlights
Nasopharyngeal carcinoma (NPC) is a common neoplasm in southern China, especially in Guangdong Province and Guangxi Zhuangzhu Regional National Autonomy [1].The primary treatment for NPC is high-dose radiation therapy (RT), for both the primary tumor and the neck, with promising results; potential radiation complications include xerostomia, sinusitis, temporal lobe necrosis, cranial nerve palsy, and brainstem damage, as well as radiation arteritis with carotid stenosis
Retrospective chart review of 16 patients with nasopharyngeal carcinoma 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)
One patient underwent external carotid artery ligation and one patient recovered without treatment
Summary
Nasopharyngeal carcinoma (NPC) is a common neoplasm in southern China, especially in Guangdong Province and Guangxi Zhuangzhu Regional National Autonomy [1]. The primary treatment for NPC is high-dose radiation therapy (RT), for both the primary tumor and the neck, with promising results; potential radiation complications include xerostomia, sinusitis, temporal lobe necrosis, cranial nerve palsy, and brainstem damage, as well as radiation arteritis with carotid stenosis. Intractable epistaxis resulting from radiotherapy alone is a medical emergency. Angiography and endovascular treatment have been used as part of the protocol in management of the condition. The purpose of this paper is to report the clinical manifestations, bleeding point localization by angiography, endovascular management, and some important related measurements in 16 instances of intractable epistaxis in 16 patients with NPC
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