Treatment of intractable epistaxis in patients with nasopharyngeal cancer

• Published in: Annals of medicine (Helsinki) Vol. 55; no. 1; p. 2200257
• Main Authors: Yang, Xiaojing, Ren, Hanru, Li, Minghua, Zhu, Yueqi, Zhang, Weitian, Fu, Jie
• Format: Journal Article
• Language: English
• Published: England Taylor & Francis 12.12.2023; Taylor & Francis Group
• Subjects: Carotid Arteries; carotid blowout; covered stent; Embolization, Therapeutic - adverse effects; Embolization, Therapeutic - methods; epistaxis; Epistaxis - complications; Epistaxis - therapy; Humans; Nasopharyngeal cancer; Nasopharyngeal Carcinoma - complications; Nasopharyngeal Carcinoma - therapy; Nasopharyngeal Neoplasms - complications; Nasopharyngeal Neoplasms - radiotherapy; Oncology; radiotherapy; Review; radiotherapy; Nasopharyngeal cancer; covered stent; carotid blowout; epistaxis
• ISSN: 0785-3890; 1365-2060
• DOI: 10.1080/07853890.2023.2200257

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. Highlights The 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.