2022-06-06 12:32:09
Journal Scan – This Month in Other Journals, June 2022
https://www.ajnrblog.org/2022/06/05/journal-scan-this-month-in-other-journals-june-2022/
1. Stevens MN, Gallant JN, Feldman MJ, et al. Management of postradiation late hemorrhage following treatment for HPV-positive oropharyngeal squamous cell carcinoma. Head Neck 2022;44:1079–85. Abstract available from: https://pubmed.ncbi.nlm.nih.gov/35150023/
Acute hemorrhage is an uncommon but potentially deadly complication for patients with head and neck cancer, especially in patients receiving RT. Previous reports have focused on hemorrhage following RT in all head and neck subsites without isolating HPV-positive malignancies. In this article, the authors focus specifically on patients with previously treated HPV-positive OPSCC given (1) the increasing prevalence and survival of this population and (2) the critical role RT plays in its treatment. They detail patient characteristics and cancer treatments leading to hemorrhagic events and include the acute interventions used in these life-threatening situations to better characterize this patient population.
A total of 12 patients with HPV-positive OPSCC were included. Six patients had base of tongue (BoT) tumors and 6 patients had tonsil tumors. The majority of patients were male (83%) with a mean age at diagnosis of 58 years. Fifty percent had advanced primary tumors (T3/T4). Median time from completion of chemoradiation to first hemorrhagic event was 186 days (range 66–1466 days). Seven patients (58%) required intervention to secure their airway. All patients were evaluated for endovascular intervention, 6 (50%) were embolized. Eight patients (67%) had a second hemorrhagic event; median time to second bleed was 22 days (range 3–90 days).
CTA was performed for 11 patients and demonstrated active extravasation in 1 patient, pseudoaneurysm (2), a combination of both extravasation and pseudoaneurysm (1), luminal irregularity (5), and no radiographic indication of vessel abnormality (2).
Seven of the 12 patients in the cohort ultimately required tracheostomy to secure their airway. In this study population, once the airway was established, attention was turned to control of hemorrhage with oropharyngeal packing with …
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