Document Detail


Acute arterial hemorrhage following radiotherapy of oropharyngeal squamous cell carcinoma.
MedLine Citation:
PMID:  20437014     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND AND PURPOSE: Vascular erosion is a rare but life-threatening complication after radiotherapy. The authors report on acute arterial bleeding and its therapy following radiotherapy of oropharyngeal tumors. PATIENTS AND METHODS: Ten patients with oropharyngeal squamous cell carcinoma of any stage developed foudroyant acute arterial hemorrhage 3-46 months (14.4 +/- 5.1 months) after primary (5/10) or adjuvant radio(chemo)therapy (R[C]T). RESULTS: All patients had a history of recurrent minor bleeding episodes and showed deep mucosal ulcerations also outside the primary tumor region. A life-threatening arterial hemorrhage appeared in the area of these mucosal defects in the pharyngeal region. Affected vessels were the common carotid artery as well as the internal and the external portion with branches like the ascending pharyngeal and superior thyroid arteries. Treatment consisted of emergency intubation or tracheotomy followed by exposure and package of the pharynx and surgical ligature and/or embolization. 6/10 patients (all hospitalized) survived the episode, however, lethal outcome in 4/10 patients (outpatients) was related to asphyxia as a result of blood aspiration or exsanguination. None of the patients revealed evidence of persistent or recurrent tumor disease as proven by biopsy/autopsy and imaging technique. CONCLUSION: Vascular erosion following primary or adjuvant R(C)T represents a rare and potentially life-threatening complication requiring immediate emergency treatment involving head and neck surgeons, anesthesiologists and neuroradiologists. For patients with oropharyngeal neoplasms treated by R(C)T and showing recurrent bleeding episodes and mucosal ulceration particularly after the acute treatment phase, hospitalization with prophylactic surgical ligature or embolization of affected arteries is recommended.
Authors:
Jens Greve; Murat Bas; Patrick Schuler; Bernd Turowski; Kathrin Scheckenbach; Wilfried Budach; Edwin B?lke; Christoph Bergmann; Stephan Lang; Diana Arweiler-Harbeck; G?tz Lehnerdt; Stefan Mattheis; Henning Bier; Thomas K Hoffmann
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Publication Detail:
Type:  Journal Article     Date:  2010-04-26
Journal Detail:
Title:  Strahlentherapie und Onkologie : Organ der Deutschen R?ntgengesellschaft ... [et al]     Volume:  186     ISSN:  1439-099X     ISO Abbreviation:  Strahlenther Onkol     Publication Date:  2010 May 
Date Detail:
Created Date:  2010-05-10     Completed Date:  2010-05-28     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8603469     Medline TA:  Strahlenther Onkol     Country:  Germany    
Other Details:
Languages:  eng     Pagination:  269-73     Citation Subset:  IM    
Affiliation:
Department of Otorhinolaryngology, University of Duisburg-Essen, Essen, Germany. jens.greve@uk-essen.de
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MeSH Terms
Descriptor/Qualifier:
Acute Disease
Aged
Arteries / pathology
Carcinoma, Squamous Cell / mortality,  pathology,  radiotherapy*
Carotid Artery Diseases / etiology*,  therapy
Chemotherapy, Adjuvant / adverse effects*
Combined Modality Therapy / adverse effects
Embolization, Therapeutic
Female
Follow-Up Studies
Head and Neck Neoplasms / mortality,  pathology,  radiotherapy
Hemorrhage / etiology*,  therapy
Humans
Male
Middle Aged
Neoplasm Staging
Oropharyngeal Neoplasms / mortality,  radiotherapy*
Radiotherapy / adverse effects*
Radiotherapy Dosage
Survivors
Time Factors

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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