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Retrospective analysis of massive epistaxis and pseudoaneurysms in nasopharyngeal carcinoma after radiotherapy

  • Rhinology
  • Published:
European Archives of Oto-Rhino-Laryngology Aims and scope Submit manuscript

Abstract

Objective

Epistaxis after radiotherapy for nasopharyngeal carcinoma (NPC) is a common clinical critical illness, which often leads to death of patients. This article focuses on the relationship between massive epistaxis and pseudoaneurysm after radiotherapy in patients with NPC and discusses clinically relevant treatment strategies.

Methods

A review was performed in 21 patients with massive epistaxis after radiotherapy for NPC from January 2011 to December 2019, and all of the patients were examined by computed tomography angiography (CTA). We also reviewed the English literature over the past 10 years to analyze the characteristics and related causes of pseudoaneurysms in terms of the clinical stage of NPC, course of radiotherapy, and affected artery. An analysis was performed on the methods of endovascular interventional treatment of such pseudoaneurysms.

Results

Among the 21 patients, 19 cases had bone destruction of the skull base; 13 cases were also found to have tumor recurrence; 15 cases were in stage III or IV of NPC; pseudoaneurysms were observed in 14 cases, of which nine cases had pseudoaneurysms in the internal carotid artery (ICA), and the rest had pseudoaneurysms in the external carotid artery (ECA). These data were consistent with the results of the literature review. Analysis with imaging revealed that the petrous ICA was the common predilection site. There were 11 out of 14 cases of pseudoaneurysms with sentinel hemorrhage in the initial phase. All 14 pseudoaneurysm patients underwent endovascular interventional therapy, but one died from hemorrhagic shock during the procedure. No rebleeding was observed among the other patients during 72 h after intravascular treatment. Nevertheless, regrettably two patients died on the 10th and 17th days after intervention.

Conclusion

Pseudoaneurysm, which was a serious complication after radiotherapy in patients with NPC, could cause massive epistaxis with high mortality. The formation of a pseudoaneurysm was closely associated with a high carcinoma stage, re-radiotherapy, and local bone destruction and infection. Most cases had sentinel epistaxis, which was considered the bleeding characteristic. The imaging material prompted that pseudoaneurysm had a predisposition to the petrous part of the ICA, while the preferred therapy was endovascular embolization treatment.

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Abbreviations

NPC:

Nasopharyngeal carcinoma

CBS:

Carotid blowout syndrome

ICA:

Internal carotid artery

ECA:

External carotid artery

CCA:

Common carotid artery

CTA:

Computed tomography angiography

DSA:

Digital subtraction angiography

BOT:

Balloon occlusion test

IMRT:

Intensity-modulated radiation therapy

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Funding

This study was supported by the National Natural Science Foundation of China (Grant no. 81860182) and the Natural Science Foundation of Jiangxi Province (Grant no.20181BAB205036).

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Authors and Affiliations

  1. Department of Otorhinolaryngology, Head and Neck Surgery, The First Affiliated Hospital of Nanchang University, No.17 Yongwaizheng Street, Nanchang, 330006, Jiangxi, China

    Liang Zeng, Wei Wan, Qing Luo, Hongqun Jiang & Jing Ye

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  1. Liang Zeng
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  2. Wei Wan
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  3. Qing Luo
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  4. Hongqun Jiang
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  5. Jing Ye
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Correspondence to Jing Ye.

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Zeng, L., Wan, W., Luo, Q. et al. Retrospective analysis of massive epistaxis and pseudoaneurysms in nasopharyngeal carcinoma after radiotherapy. Eur Arch Otorhinolaryngol 279, 2973–2980 (2022). https://doi.org/10.1007/s00405-021-07111-x

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  • DOI: https://doi.org/10.1007/s00405-021-07111-x

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