Treatment of intractable epistaxis in patients with nasopharyngeal cancer

Xiaojing Yang; Hanru Ren; Minghua Li; Yueqi Zhu; Weitian Zhang; Jie Fu

doi:10.1080/07853890.2023.2200257

Treatment of intractable epistaxis in patients with nasopharyngeal cancer

Ann Med. 2023 Dec;55(1):2200257. doi: 10.1080/07853890.2023.2200257.

Authors

Xiaojing Yang¹, Hanru Ren², Minghua Li³, Yueqi Zhu³, Weitian Zhang⁴, Jie Fu¹

Affiliations

¹ Department of Radiation Oncology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
² Department of Orthopedics, Shanghai Pudong Hospital, Pudong Medical Center, Fudan University, Shanghai, P. R. China.
³ Department of Diagnostic and Interventional Radiology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
⁴ Department of Otorhinolaryngology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.

Abstract

Aim: To investigate the treatment of intractable epistaxis after radiotherapy for nasopharyngeal carcinoma (NPC).Methods: This review focuses on the anatomy and pathophysiology, mechanism, and clinical treatments of epistaxis after NPC radiotherapy.Results: For treating NPC, radiation therapy is the primary therapeutic modality. However, radiotherapy can lead to varied degrees of harm to the neighboring tissues and is correlated with numerous complications. Among these complications, epistaxis is a common occurrence after NPC radiotherapy, owing to damage to the surrounding tissues caused by radiotherapy. Unfortunately, epistaxis, particularly carotid blowout, can have a dangerous course and a high mortality rate. Accurate understanding of epistaxis following radiotherapy, prompt bleeding cessation, and reduction of bleeding volume are key considerations. Nasal tamponade is a crucial rescue treatment, while tracheotomy is an active and effective method. Intravascular balloon embolization is a reliable and effective treatment method for ICA hemorrhage, and vascular embolization is the primary approach for treating external carotid artery maxillary bleeding. Implantation of a covered stent can achieve hemostasis without altering hemodynamics.Conclusion: A comprehensive approach utilizing these methods can improve the success rate of treating nosebleeds following NPC radiotherapy.HighlightsThe mortality rate for carotid blowout following radiotherapy for NPC is high.Radiation therapy and tumor condition are correlated with epistaxis in NPC.Treatment methods for NPC-related epistaxis include posterior nostril tamponade, endoscopic hemostasis, DSA, selective vascular embolization, and stent implantation.The use of a covered stent for NPC-related carotid blowout achieves hemostasis without altering blood perfusion.Effective and timely application of various hemostasis methods is key to improving the success rate of rescue, considering the characteristics of NPC-related epistaxis.

Keywords: Nasopharyngeal cancer; carotid blowout; covered stent; epistaxis; radiotherapy.

Publication types

Review
Research Support, Non-U.S. Gov't

MeSH terms

Carotid Arteries
Embolization, Therapeutic* / adverse effects
Embolization, Therapeutic* / methods
Epistaxis / complications
Epistaxis / therapy
Humans
Nasopharyngeal Carcinoma / complications
Nasopharyngeal Carcinoma / therapy
Nasopharyngeal Neoplasms* / complications
Nasopharyngeal Neoplasms* / radiotherapy

Grants and funding

Xiaojing Yang is the recipient of a grant from the Shanghai Jiao Tong University Affiliated Sixth People’s Hospital [contract grant number: ynqn202118]. Weitian Zhang is the recipient of a grant from Science and Technology Innovation Action Plan of Shanghai Municipal Science and Technology Commission [No. 19411950700].