Major haemorrhage after non-surgical management of oropharyngeal squamous cell carcinoma

Abstract

Objectives: Major haemorrhage is a rare complication after chemoradiotherapy for oropharyngeal squamous cell carcinoma. This is managed by interventional neuroradiology with endovascular embolisation of the bleeding vessel. This study aimed to describe radiological and clinical predictors of haemorrhage.

Methods: A retrospective case series was conducted of all patients with oropharyngeal squamous cell carcinomas who suffered a major haemorrhage requiring embolisation during or after treatment with chemoradiotherapy or radiotherapy alone, between 2013 and 2021, in Western Australia.

Results: This study included 14 patients, in two groups: haemorrhage group (n = 70) and tumour stage matched non-haemorrhage group (n = 7). Patients who haemorrhaged had a larger average transverse axial tumour size on pre-treatment computed tomography (38 mm vs 22 mm; p = 0.02) and tumours tended to involve the proximal aspect of the offending bleeding vessel. All patients who haemorrhaged developed deep cavitating or ulcerative tumour bed changes on post-treatment imaging (p < 0.0001).

Conclusion: Tumour bed ulceration or cavitation appears to be highly predictive of haemorrhage in this patient cohort.

Keywords: Hemorrhage; Oropharynx; Squamous Cell Carcinoma.