Postirradiated carotid blowout syndrome in patients with nasopharyngeal carcinoma: a case-control study

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 syndrome was 3.599 between patients with or without reirradiation (95% confidence interval, 1.465-8.839; p = .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 mentioned in the informed consent form before treatment.

Keywords: carotid blowout syndrome; chemotherapy; nasopharyngeal carcinoma; osteoradionecrosis; radiotherapy.