Treatment of intractable epistaxis in patients with nasopharyngeal cancer

Figures & data

Figure 1. (A) Schematic diagram of the internal carotid artery in the human body (highlighted: internal carotid artery); (B) The seven segments of the internal carotid artery are shown with different marks. The left image shows the rupture and bleeding of the C2 segment of the blood vessels. The image on the right shows bleeding stopped after stent implantation; (C) A local magnification shows the use of a stent to treat an internal carotid rupture. The lower right image shows a cross-sectional view of an ordinary stent implant. The lower left image shows a cross-sectional view after the covered stent is implanted, and a white membrane is visible between the vessel wall and the stent; (D) Coronal plane and (E) axial plane: The carotid arteries and neighboring anatomic structures are shown (arrows indicate the internal carotid artery; circle shows the nasopharyngeal area).

Figure 2. An algorithm for the diagnosis and treatment of carotid blowout in NPC patients after radiotherapy.

Figure 3. (A) Image before Willis covered stent implantation (white arrow shows the bleeding site); (B) Image after Willis covered stent implantation.

Table 1. Recent reports on radiotherapy for recurrent nasopharyngeal carcinoma.

Authors (reference)	Total case	Year	reRT dose (Gy)	Median follow-up time (mo)	Massive epistaxis (no)	Massive epistaxis (%)
King et al. [11]	31	2000	55–71.2 (Mean 61.6)	38.5	1	3
Fee et al. [12]	37	2002	60–75 (Mean 68)	28.6	1	3
Hao et al. [13]	53	2008	NR	37.1	2	4
Ko et al. [14]	28	2009	NR	24	1	4
Seo et al. [15]	35	2009	7.5–12 Gy in 3–5 fr	25	3	9
Chua et al. [16]	43	2009	8–18 Gy in single fr	40	1	2
Chua et al. [16]	43	2009	20–49 Gy in 4–6 fr	24	2	4
Vlantis et al. [17]	97	2011	40–50 Gy	>24	3	3
Wei et al. [18]	246	2011	NR	38	2	1
Ozyigit et al. [19]	24	2011	6 Gy in 5 fr	23	4	17
Qiu et al. [20]	70	2012	50–77.4 (Median 70)	25	6	9
Chen et al. [21]	54	2013	49.8–76.6 (Mean 70)	17	6	11
Tian et al. [22]	117	2015	65.4–73.1	25	22	19
Kong et al. [23]	77	2016	46.2–70 (Median 66)	26	17	22
Liu et al. [24]	91	2017	NR	23	9	10
Tian et al. [25]	245	2017	60.1–78.7 (Median 70)	24	39	16
Chan et al. [26]	38	2017	50–64.8	48	8	20
Lee et al. [27]	20	2017	60–64.8	45	3	15
Ng et al. [28]	32	2018	60	29	4	12
Ng WT et al. [29]	91	2020	Median 60	26.5	10	11
Hu et al. [10]	206	2020	50–69 (GyE) (2.0–3.0 GyE per fraction)	22.8	16	8

Abbreviations: RT: radiation; reRT: reirradiation; NR: not reported; Mo = months; GyE: gray equivalent.

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