Transarterial embolization for control of bleeding in patients with head and neck cancer

Abstract

Objective: This study evaluated the efficacy of transarterial embolization for the treatment of tumor bleeding in neck tumors following radiation or chemotherapy.

Study design: We performed a case series with chart review of 25 patients with clinically suspected tumor bleeding that occurred in the period between August 2003 and April 2007.

Setting: All patients were admitted to and accepted treatment at China Medical University Hospital, Taiwan, R.O.C.

Subjects and methods: Twenty-five male patients (aged 32 to 88 years) with pathologically verified malignant carcinomas of the neck received radiotherapy (n = 6), radiotherapy and chemotherapy (n = 7), or initial surgery and palliative radiotherapy or chemotherapy (n = 12). Carotid artery angiography was performed to detect tumor bleeding, and affected vessels were embolized using either Gelfoam sponge (or cubes), coils, microcoils, or a combination of these methods.

Results: By angiography, patients showed tumor vessels with tumor stain (n = 13), extravasation of the contrast agent (n = 7), stenotic vessels (n = 5), pseudoaneurysm (n = 4), and arteriovenous shunt (n = 1). Transarterial embolization was performed with catheter insertion through the branches of the external carotid artery (n = 18), the external carotid artery (n = 5), or the internal carotid artery (n = 1). All patients showed dramatic clinical improvement following embolization. Patients with tongue cancer had the longest average post-transarterial embolization hospital stay (21 days) and the highest incidence of aspiration pneumonia (3/9). After two months of follow-up, five patients had experienced rebleeding.

Conclusion: Specific vessel injuries following radiation or chemotherapy require different kinds of endovascular treatment. Patients with tongue cancer should be carefully monitored for aspiration pneumonia.