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Major haemorrhage after non-surgical management of oropharyngeal squamous cell carcinoma

Published online by Cambridge University Press:  18 August 2022

S Leedman Open the ORCID record for S Leedman [Opens in a new window] ,
A Thompson ,
T Phillips  and
C Sader
S Leedman*
Affiliation:
Department of Otolaryngology Head and Neck Surgery, Sir Charles Gairdner Hospital, Perth, Australia
A Thompson
Affiliation:
Neurological Intervention and Imaging Service of Western Australia (‘NIISwa’), Sir Charles Gairdner Hospital, Perth, Australia
T Phillips
Affiliation:
Neurological Intervention and Imaging Service of Western Australia (‘NIISwa’), Sir Charles Gairdner Hospital, Perth, Australia
C Sader
Affiliation:
Department of Otolaryngology Head and Neck Surgery, Sir Charles Gairdner Hospital, Perth, Australia
*
Author for correspondence: Dr Samuel Leedman, Department of Otolaryngology Head and Neck Surgery, Sir Charles Gairdner Hospital, Hospital Avenue, Nedlands, Perth, WA 6009, Australia E-mail: samleedman@gmail.com
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Abstract

Objectives

Major haemorrhage is a rare complication after chemoradiotherapy for oropharyngeal squamous cell carcinoma. This is managed by interventional neuroradiology with endovascular embolisation of the bleeding vessel. This study aimed to describe radiological and clinical predictors of haemorrhage.

Methods

A retrospective case series was conducted of all patients with oropharyngeal squamous cell carcinomas who suffered a major haemorrhage requiring embolisation during or after treatment with chemoradiotherapy or radiotherapy alone, between 2013 and 2021, in Western Australia.

Results

This study included 14 patients, in two groups: haemorrhage group (n = 70) and tumour stage matched non-haemorrhage group (n = 7). Patients who haemorrhaged had a larger average transverse axial tumour size on pre-treatment computed tomography (38 mm vs 22 mm; p = 0.02) and tumours tended to involve the proximal aspect of the offending bleeding vessel. All patients who haemorrhaged developed deep cavitating or ulcerative tumour bed changes on post-treatment imaging (p < 0.0001).

Conclusion

Tumour bed ulceration or cavitation appears to be highly predictive of haemorrhage in this patient cohort.

Keywords

OropharynxSquamous Cell CarcinomaHemorrhage
Type
Main Article
Information
The Journal of Laryngology & Otology , Volume 137 , Issue 6 , June 2023 , pp. 667 - 672
Copyright
Copyright © The Author(s), 2022. Published by Cambridge University Press on behalf of J.L.O. (1984) LIMITED

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Footnotes

Dr S Leedman takes responsibility for the integrity of the content of the paper

References

Rahman, QB, Iocca, O, Kufta, K, Shanti, RM. Global burden of head and neck cancer. Oral Maxillofac Surg Clin North Am 2020;32:367–75CrossRefGoogle ScholarPubMed
Pignon, JP, le Maitre, A, Maillard, E, Bourhis J;, MACH-NC Collaborative Group. Meta-analysis of chemotherapy in head and neck cancer (MACH-NC): an update on 93 randomised trials and 17,346 patients. Radiother Oncol 2009;92:4–1410.1016/j.radonc.2009.04.014CrossRefGoogle ScholarPubMed
Smith, RV, Schiff, BA, Garg, M, Haigentz, M. The impact of transoral robotic surgery on the overall treatment of oropharyngeal cancer patients. Laryngoscope 2015;125(suppl 10):S1–15CrossRefGoogle ScholarPubMed
Glenny, AM, Furness, S, Worthington, HV, Conway, DI, Oliver, R, Clarkson, JE et al. Interventions for the treatment of oral cavity and oropharyngeal cancer: radiotherapy. Cochrane Database Syst Rev 2010;(12):CD006387Google ScholarPubMed
Self, EM, Bumpous, J, Ziegler, C, Wilson, L, Potts, K. Risk factors for hemorrhage after chemoradiation for oropharyngeal squamous cell carcinoma. JAMA Otolaryngol Head Neck Surg 2013;139:356–61CrossRefGoogle ScholarPubMed
Chou, CT, Rath, TJ, Johnson, JT, Goyal, LK. Catastrophic hemorrhage after chemoradiation for advanced stage oropharyngeal carcinoma: a case series. Laryngoscope 2021;131:1049–5210.1002/lary.29167CrossRefGoogle ScholarPubMed
Amin, M, Edge, S, Greene, F, Byrd, D, Brookland, R, Washington, M et al. AJCC Cancer Staging Manual, 8th edition. New York: Springer International Publishing, 2017CrossRefGoogle ScholarPubMed
Charlson, ME, Pompei, P, Ales, KL, MacKenzie, CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 1987;40:373–83CrossRefGoogle ScholarPubMed