ORIGINAL ARTICLE
Postirradiated carotid blowout syndrome in patients with nasopharyngeal carcinoma: A case–control study Kun-Chih Chen, MD,1 Ting-Ting Yen, MD,1 Yi-Ling Hsieh, MD,1 Hung-Chieh Chen, MD,2 Rong-San Jiang, MD, PhD,1,3 Wen-Hsien Chen, MD,2 Kai-Li Liang, MD1,3,4* 1
Department of Otolaryngology, Taichung Veterans General Hospital, Taichung, Taiwan, 2Department of Radiology, Taichung Veterans General Hospital, Taichung, Taiwan, School of Medicine, Chung Shan Medical University, Taichung, Taiwan, 4Department of Medicine, National Yang-Ming Medical University, Taipei, Taiwan.
3
Accepted 4 March 2014 Published online 19 June 2014 in Wiley Online Library (wileyonlinelibrary.com). DOI 10.1002/hed.23671
ABSTRACT: Background. Carotid blowout syndrome is one of the most devastating complications of nasopharyngeal carcinoma (NPC) therapy. Methods. A retrospective review was conducted from January 2004 to April 2013. Thirty-one patients with carotid blowout syndrome were enrolled and a case control study was conducted to analyze the risk factors. Results. When a comparison was made between the carotid blowout syndrome and matched non-bleeding group, there was a significantly higher local recurrence rate and prevalence of skull base osteoradionecrosis (ORN) in the carotid blowout syndrome group compared to those of the control group (both p < .001). The hazard ratio of carotid blowout
INTRODUCTION Nasopharyngeal carcinoma (NPC) is a common neoplasm in southern China, Hong Kong, and Taiwan.1 Radiotherapy is the primary curative treatment for NPC. With the advancement of radiation techniques and combination with chemotherapy, excellent long-term survival can be achieved in most patients without metastatic diseases.2,3 However, late treatment toxicity has become an important issue among survivors.4 Carotid blowout syndrome, the rupture of the carotid artery or one of its main branches, is an uncommon but devastating complication of irradiated NPC. Carotid blowout syndrome results from the loss of soft tissue protecting the carotid artery system. Etiologies of carotid blowout syndrome include tumor involvement in head and neck cancer, tissue necrosis after surgery or radiotherapy, blunt or penetration wound, and iatrogenic injury during operation.5 Carotid blowout syndrome is further classified into 3 disease entities, including threatened, impending, and acute carotid blowout.6 Threatened carotid blowout is defined as a scenario of an exposed carotid artery resulting from prior radiotherapy or surgery. Bleeding is inevitable without aggressive
syndrome was 3.599 between patients with or without reirradiation (95% confidence interval, 1.465–8.839; p 5 .005, adjusted for nasopharyngectomy and chemotherapy) using a Cox proportional hazard model. Conclusion. Reirradiation and skull base ORN are strong predisposing factors for carotid blowout syndrome, and therefore they should be menC 2014 Wiley tioned in the informed consent form before treatment. V Periodicals, Inc. Head Neck 37: 794–799, 2015
KEY WORDS: carotid blowout syndrome, chemotherapy, nasopharyngeal carcinoma, osteoradionecrosis, radiotherapy
wound management in patients with threatened carotid blowout. Impending carotid blowout indicates a scenario of intermittent oronasal bleeding or bleeding through a radionecrotic or a surgical wound, which can be stopped spontaneously or by pressure packing. However, the hemorrhage of acute carotid blowout is profuse and usually cannot be stopped by pressure packing. The reported morbidity and mortality rates of carotid blowout are 40% and 60%, respectively, and the survival is usually
Postirradiated carotid blowout syndrome in patients with nasopharyngeal carcinoma: A case–control study Kun-Chih Chen, MD,1 Ting-Ting Yen, MD,1 Yi-Ling Hsieh, MD,1 Hung-Chieh Chen, MD,2 Rong-San Jiang, MD, PhD,1,3 Wen-Hsien Chen, MD,2 Kai-Li Liang, MD1,3,4* 1
Department of Otolaryngology, Taichung Veterans General Hospital, Taichung, Taiwan, 2Department of Radiology, Taichung Veterans General Hospital, Taichung, Taiwan, School of Medicine, Chung Shan Medical University, Taichung, Taiwan, 4Department of Medicine, National Yang-Ming Medical University, Taipei, Taiwan.
3
Accepted 4 March 2014 Published online 19 June 2014 in Wiley Online Library (wileyonlinelibrary.com). DOI 10.1002/hed.23671
ABSTRACT: Background. Carotid blowout syndrome is one of the most devastating complications of nasopharyngeal carcinoma (NPC) therapy. Methods. A retrospective review was conducted from January 2004 to April 2013. Thirty-one patients with carotid blowout syndrome were enrolled and a case control study was conducted to analyze the risk factors. Results. When a comparison was made between the carotid blowout syndrome and matched non-bleeding group, there was a significantly higher local recurrence rate and prevalence of skull base osteoradionecrosis (ORN) in the carotid blowout syndrome group compared to those of the control group (both p < .001). The hazard ratio of carotid blowout
INTRODUCTION Nasopharyngeal carcinoma (NPC) is a common neoplasm in southern China, Hong Kong, and Taiwan.1 Radiotherapy is the primary curative treatment for NPC. With the advancement of radiation techniques and combination with chemotherapy, excellent long-term survival can be achieved in most patients without metastatic diseases.2,3 However, late treatment toxicity has become an important issue among survivors.4 Carotid blowout syndrome, the rupture of the carotid artery or one of its main branches, is an uncommon but devastating complication of irradiated NPC. Carotid blowout syndrome results from the loss of soft tissue protecting the carotid artery system. Etiologies of carotid blowout syndrome include tumor involvement in head and neck cancer, tissue necrosis after surgery or radiotherapy, blunt or penetration wound, and iatrogenic injury during operation.5 Carotid blowout syndrome is further classified into 3 disease entities, including threatened, impending, and acute carotid blowout.6 Threatened carotid blowout is defined as a scenario of an exposed carotid artery resulting from prior radiotherapy or surgery. Bleeding is inevitable without aggressive
syndrome was 3.599 between patients with or without reirradiation (95% confidence interval, 1.465–8.839; p 5 .005, adjusted for nasopharyngectomy and chemotherapy) using a Cox proportional hazard model. Conclusion. Reirradiation and skull base ORN are strong predisposing factors for carotid blowout syndrome, and therefore they should be menC 2014 Wiley tioned in the informed consent form before treatment. V Periodicals, Inc. Head Neck 37: 794–799, 2015
KEY WORDS: carotid blowout syndrome, chemotherapy, nasopharyngeal carcinoma, osteoradionecrosis, radiotherapy
wound management in patients with threatened carotid blowout. Impending carotid blowout indicates a scenario of intermittent oronasal bleeding or bleeding through a radionecrotic or a surgical wound, which can be stopped spontaneously or by pressure packing. However, the hemorrhage of acute carotid blowout is profuse and usually cannot be stopped by pressure packing. The reported morbidity and mortality rates of carotid blowout are 40% and 60%, respectively, and the survival is usually
