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Case Reports
. 2013 Jun 13:6:703-6.
doi: 10.2147/OTT.S44214. Print 2013.

Fatal bleeding in a nasopharyngeal carcinoma patient after concurrent chemoradiation plus cetuximab: a case report

Lingyan Zheng  1 , Senxiang Yan, Danfang Yan, Jingsong Yang, Yixiang Wang
Affiliations
Case Reports

Fatal bleeding in a nasopharyngeal carcinoma patient after concurrent chemoradiation plus cetuximab: a case report

Lingyan Zheng et al. Onco Targets Ther. .

Abstract

Carotid blowout syndrome (CBS) refers to the clinical signs and symptoms related to rupture of the carotid artery (CA) and its branches, which mainly results from malignant invasion of the CA by head and neck cancers. Here, we present a 46-year-old male patient who suffered from nasopharyngeal carcinoma and was treated with a combination of chemoradiation and cetuximab. The patient was stage IVb (T4N2M0) clinically, with encasement of the left internal carotid artery, as shown on pretreatment magnetic resonance imaging. Three months after completion of radiotherapy, the patient died of sudden massive epistaxis. CBS is a lethal complication of nasopharyngeal carcinoma, so the risk of CBS should be carefully assessed in patients with imaging showing CA encasement. Till now, the precise prediction and prevention of CBS remain to be explored.

Keywords: carotid blowout syndrome; cetuximab; diagnosis; nasopharyngeal carcinoma; prevention.

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Figures

Figure 1
Figure 1
(A–D) MRI study of the left-sided nasopharyngeal carcinoma before combined CRT plus cetuximab therapy, showing extensive involvement of the left prevertebral and the pterygoid muscles with encasement of the left ICA (A: axial T1WI, B: T2WI with fat suppression, C: Gd+T1WI; D: magnification of the lesion in C). (E and F) One month after treatment (E: Gd+T1WI shows patchy unenhanced areas in the center of the lesion, representing foci of necrosis; F: coronal Gd+T1WI shows the ICA meandering through the lesion). (G and H) Three months after treatment (G: Gd+T1WI shows large unenhanced area, bordering the ICA, in the lesion; H: T2WI shows the unenhanced area to be of moderately high signal intensity, representing coagulative necrosis of the lesion) Notes: Arrowheads indicate the left ICA; arrows indicate coagulative necrosis in the lesion. Abbreviations: MRI, magnetic resonance imaging; ICA, internal carotid artery; CRT, chemoradiation; T1WI, T1-weighted imaging; T2WI, T2-weighted imaging; Gd+T1WI, gadolinium-enhanced T1-weighted imaging.
Figure 2
Figure 2
A dosimetric map around the encased carotid artery. Note: A point dose of 7250 cGy (104% of the prescribed dose) is indicated within the artery.
See this image and copyright information in PMC

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