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

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, micro-coils, 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. (C) 2010 American Academy of Otolaryngology Head and Neck Surgery Foundation. All rights reserved.