Carotid blowout syndrome in patients treated by larynx cancer

Estomba, Carlos Miguel Chiesa; Reinoso, Frank Alberto Betances; Velasquez, Alejandra Osorio; Macía, Olalla Castro; Cortés, María Jesús González; Nores, Jesús Araujo

doi:10.1016/j.bjorl.2016.08.013

Cited by 20 publications

(29 citation statements)

References 18 publications

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“…They also had tumours in earlier stages than patients who were treated by radiotherapy or CRT together with resection, and were therefore more likely to survive. It has been reported that higher doses of chemotherapy and radiotherapy together with extensive resection will increase the risk of lethal complications [32]. Patients with advanced cancers of the head and neck who were admitted to hospital for more than five days during or after radiotherapy had worse locoregional control, progression-free survival, and overall survival [33].…”

Section: Discussionmentioning

confidence: 99%

Early mortality after diagnosis of cancer of the head and neck – A population-based nationwide study

Talani¹,

Mäkitie²,

Beran³

et al. 2019

PLoS ONE

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BackgroundCancers of the head and neck have a high mortality rate, and roughly 10% of the patients die within six months of diagnosis. To our knowledge little has been written about this group.We wished to identify risk factors for early death, to predict and monitor patients at risk better and, if possible, avoid unjustified major treatment.Methods and findingsThis population-based nationwide study from the Swedish Head and Neck Cancer Register (SweHNCR) included data from 2008–2015 and 9733 patients at potential risk of early death.A total of 925 (9.5%) patients died within six months. For every year older the patients became, the risk of early death increased by 2.3% (p<0.001). The relative risk of death was 3.37 times higher (237%) for patients with WHO score 1 compared with WHO score 0. A primary tumour in the hypopharynx correlated with a 24% increased risk over the oral cavity (p<0.024). Patients with stage IV disease had a 3.7 times greater risk of early death than those with stage I (p<0.001). As expected, a 12 times increased risk of early death was noted in the palliative treatment group, compared to the curative group.Limitations to this study were that the actual cause of death was not recorded in the SweHNCR, and that socioeconomic factors, alcohol consumption, smoking habits, and HPV status, were not reported in SweHNCR until 2015. However, the fact that this is a population-based nationwide study including 9733 patients compensates for some of these limitations.ConclusionsIdentification of patients at increased risk of early death shows that older patients with advanced disease, increased WHO score, primary tumour in the hypopharynx, and those given palliative treatment, are more likely than the others to die from head and neck cancer within six months of diagnosis.

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Section: Discussionmentioning

confidence: 99%

Early mortality after diagnosis of cancer of the head and neck – A population-based nationwide study

Talani¹,

Mäkitie²,

Beran³

et al. 2019

PLoS ONE

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“…Progressive fibrosis, thrombosis and obliteration of the vasa-vasorum, and weakening of the arterial walls may be observed in histologic examinations of carotid arteries, placing them at risk for rupture from nearby cartilaginous or osseous fragments. [ 2 , 21 ] This predisposes laryngeal CRN patients to CBS, which was observed in 5 (38.5%) of our cases, and 3 (60%) patients expired. In a study by McCready et al, a total radiation dose of 40 Gy in 10 days may induce damage to the vasa-vasorum and may contribute to rupture of the great arteries in dogs.…”

Section: Discussionmentioning

confidence: 70%

Carotid arterial blowout after organ preserving chemoradiation therapy in hypopharyngeal cancer

et al. 2022

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Laryngeal preserving concurrent chemoradiation has been advocated for hypopharyngeal cancers. The use of radiotherapy (RT) in the larynx could lead to increased rates of radionecrosis. In this study, we investigated a rare but disastrous complication, carotid blow-out syndrome (CBS), related with the persistent radionecrosis. Retrospective cohort study. This retrospective study enrolled hypopharyngeal cancer patients with biopsy-proven pharyngeal and laryngeal chondronecrosis (PLCRN), which was rated by the Chandler Grading System. From 2002 to 2018, a total of 346 hypopharygeal cancer patients received upfront radiation therapy, 13 PLCRN patients were identified in a rate of 3.8%. All PLRN patients received RT with a mean radiation dose of 70.81 ± 0.85 Gy. All patients had Chandler Grade IV at the time of presentation, which was a mean of 15.08 months (range: 5‐109 months) from the time of cancer diagnosis to PLCRN diagnosis. In 5 of the 13 PLCRN patients developed CBS. Three of the CBS originated from superior thyroid artery, one from lingual artery and one from the carotid artery. Three (60%) of the 5 CBS patients expired due to loss of airway and hemodynamic instability. Two (40%) were rescued by emergent airway secure and emergent angiographic embolization. Persistent PLCRN could lead to disastrous vascular complications. CBSs were demonstrated to be more frequently originated from the branches of carotid artery rather than carotid artery per se. Clinical alert with early airway protection could strive for time to do interventions and prevent mortalities.

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“…Advanced tumor staging and local recurrence along with open surgical procedures also increase the risk of CBOD-related death. 37 38 39 40 …”

Section: Discussionmentioning

confidence: 99%

Cyberknife Radiosurgery for the Treatment of Head and Neck Cancer: A Systematic Review

et al. 2021

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Cyberknife radiosurgery is a frameless stereotactic robotic radiosurgery which has shown to deliver better treatment outcomes in the treatment of advanced head and neck (H&N) carcinomas, especially in previously irradiated and recurrent cases. The aim of the study was to perform a systematic review of the available data on the outcomes of Cyberknife radiosurgery for treatment of head and neck cancer and to evaluate its collective outcomes. This systematic review was registered with the university with the registration no. FRP/2019/63 and was approved by the Institutional Review Board (RC/IRB/2019/132). Literature search was performed in the following: PubMed, Science direct, SciELO, MyScienceWork, Microsoft Academ EMBASE, Directory of Open Access Journals, and Cochrane databases with the keywords “Cyberknife,” “oral cancer,” “oropharyngeal cancer,” and “head and neck cancer” and data was extracted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The records identified were 147 manuscripts. Excluded articles included 5 duplicate articles, 33 abstracts, 101 full text articles due to being off-topic, case reports, review, non-English, 1 survey, and 2 other articles containing data extracted from a main study which was already included. A total of 5 articles were evaluated for qualitative synthesis. The mean dose of Cyberknife radiosurgery delivered for previously irradiated recurrent H&N carcinoma patients was 34.57 Gy, with a mean sample size of 5 studied during the period of 2000 to 2016. The available evidence from the systematic review indicates that Cyberknife can be an efficacious treatment option for recurrent previously irradiated H&N carcinoma, especially for nonresectable tumors. There is paucity of homogenous data and studies in this arena; hence, meta-analysis could not be performed. Further standardized studies are essential, especially where the treatment of H&N carcinoma is considered.

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Carotid blowout syndrome in patients treated by larynx cancer

Abstract: Carotid blowout syndrome is an uncommon complication in patients treated by larynx tumours. According to our results, patient underwent radiotherapy and patients treated with open surgical procedures with pharyngeal opening have a major risk to develop this kind of complication.

Cited by 20 publications

References 18 publications

Early mortality after diagnosis of cancer of the head and neck – A population-based nationwide study

Early mortality after diagnosis of cancer of the head and neck – A population-based nationwide study

Carotid arterial blowout after organ preserving chemoradiation therapy in hypopharyngeal cancer

Cyberknife Radiosurgery for the Treatment of Head and Neck Cancer: A Systematic Review

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