Author(s)
Tuleen Sawaf, BS
Celina G. Virgen, MD MPH
Bryan Renslo, BS
Omar Karadaghy, MD
Kevin J. Sykes, PhD MPH
Andres M. Bur, MD
Affiliation(s)
University of Kansas Medical Center;
Abstract:
Educational Objective: At the conclusion of this presentation, the participants should be able to better stratify the prognosis of patients after endovascular embolization for acute hemorrhage in the setting of head and neck squamous cell carcinoma (HNSCC) previously treated with primary or adjuvant radiation therapy (RT).
Objectives: To characterize the prognosis after endovascular embolization for acute hemorrhage in patients with HNSCC previously treated with primary or adjuvant RT.
Study Design: Case series.
Methods: We identified patients who received treatment for HNSCC with primary or adjuvant RT and presented to our medical center with acute hemorrhage. Patient characteristics, oncologic history, and hemorrhage outcomes were reviewed. Those who received endovascular embolization were included, and patients with carotid blowout syndrome were excluded. Outcomes included time to hemorrhage and median survival time. Kaplan Meier survival analysis was performed.
Results: Twenty-five patients were included. Median age at diagnosis was 58.1 years (IQR: 51.2-64.8). Most primary tumors were oropharyngeal (52%), followed by oral cavity (17%). Twenty-one patients received definitive primary or adjuvant RT, and six patients received salvage RT for recurrence. Median time to hemorrhage from last treatment was 71.5 days (IQR: 16.75-186.5). Cause of hemorrhage was commonly attributed to tumor recurrence or persistent disease (60%) with embolization of the lingual artery performed in most cases (60%). Overall median survival after embolization was 1.65 months (0.92-3.25). Hemorrhage due to tumor burden resulted in trends towards shorter median survival compared to soft tissue necrosis or pseudoaneurysm (1.0 vs. 2.2 months, p=0.10). Cause of death, when known, was related to cancer progression in hospice (n=9) and persistent hemorrhage (n=3).
Conclusions: Post-treatment hemorrhage is a rare but catastrophic presentation in HNSCC. Our series demonstrates the poor prognostic significance of this presentation, suggesting the need to manage expectations for embolization and prepare patients and families for end of life discussions.