Clinicopathological Factors and Prognosis of Massive Hemorrhage After Radiotherapy for Nasopharyngeal Carcinoma

Abstract

Background: To investigate the clinicopathological factors and prognosis of nasopharyngeal hemorrhage after radiotherapy for nasopharyngeal carcinoma (NPC). Methods: The clinicopathological data of 539 NPC patients who received radiotherapy were analyzed retrospectively, including gender; age; T-stage; N-stage; pathological type; type of radiotherapy; synchronous chemotherapy; secondary-course radiotherapy; radioactive skull base osteonecrosis; diabetes, hypertension, or other systemic diseases; results of nasopharyngeal bacterial culture. Univariate and multivariate analyses were performed using the c2 test and logistic regression. The Kaplan-Meier method was applied to analyze the survival of patients with nasopharyngeal hemorrhage. Results: Among all patients, 64 (11.9%) had nasopharyngeal hemorrhage after radiotherapy. Results from the univariate analysis showed that T-stage (p<0.01), secondary-course radiotherapy (p<0.01), radioactive skull base osteonecrosis (p<0.01), nasopharyngeal bacterial culture results (p<0.01), and nasopharyngeal tumor recurrence (p<0.01) were associated with nasopharyngeal hemorrhage. Multivariate analysis showed that only radioactive skull base osteonecrosis was significantly associated with nasopharyngeal hemorrhage after radiotherapy (OR=41.83, p=0.0001). In patients with internal carotid artery hemorrhage, the survival rate was 60.9% in one year, 15.1% in3 years, and 0% in 5 years. In patients with external carotid artery bleeding, the 5-year survival rate was 50%. The main cause of death during follow-up was rebleeding. Conclusion: The rate of mortality in patients with nasopharyngeal hemorrhage after radiotherapy is high. The presence of radioactive skull base osteonecrosis is the decisive factor in patients with nasopharyngeal hemorrhage after radiotherapy. Influencing and synergistic factors include T-stage, secondary-course radiotherapy, results of nasopharyngeal bacterial culture, and nasopharyngeal tumor recurrence. After successful rescue,arterial embolization or stent implantation may prolong survival.

Local and Lymph Node Relapse of Nasopharyngeal Carcinoma: A Single-Center Experience

“…In our study, 56% of patients had a relapsed rT4 tumor and tumors initially classified as T3 or T4 relapsed as rT3 or rT4 tumors in 85.7% of cases. Wang et al 13 found in a retrospective study that T4 tumors were associated with a significant risk of LR relapse and that T stage was the only factor correlated with relapse.…”