Transcutaneous arterial embolization to control massive tumor bleeding in head and neck cancer: 63 patients’ experiences from a single medical center

Abstract

Massive tumor bleeding is a life-threatening complication in patients with head and neck cancer (HNC). Tumor hemorrhage is usually hard to localize, and medical management is often ineffective. Arterial angiography is used to visualize the source of bleeding, and concurrent transcutaneous arterial embolization (TAE) can be done to stop bleeding in some patients. We analyzed the outcome of TAE in HNC patients with massive bleeding at our institution. We retrospectively reviewed 93 angiographic procedures in 63 HNC patients. Factors potentially related to post-hemorrhagic survival were evaluated, including tumor stage (T, N, M), tumor type, previous curative-intent surgery, previous chemotherapy, previous radiotherapy, angiographic findings, the presence of embolization, and the embolization methods. A total 56 TAEs were done in 93 angiographic procedures in 63 HNC patients. The overall median post-hemorrhagic survival after angiography was 16 days (range 0-644 days). Median post-hemorrhagic survival for patients receiving TAE was 26 days (range 0-644 days), while patients who received angiography alone survived 8 days (range 0-144 days; p = 0.008). No factors other than TAE predicted post-hemorrhagic survival, and there were no major adverse events after TAE. In our hands, TAE was associated with a low incidence of toxicities commonly attributable to the procedure such as stroke. Patients who were able to undergo TAE lived longer than those who were not candidates for the procedure.