Clinicopathological factors affecting the prognosis of massive hemorrhage after radiotherapy for patients having nasopharyngeal carcinoma.

AIMS: The aim of the study is to investigate the clinicopathological factors that determine prognosis of nasopharyngeal hemorrhage after radiotherapy in patients with nasopharyngeal carcinoma (NPC). PATIENTS AND METHODS: The clinicopathological data of 539 patients with NPC, who received radiotherapy, were analyzed retrospectively. Parameters included gender; age; T-stage; N-stage; pathological type; type of radiotherapy; synchronous chemotherapy; secondary-course radiotherapy; radiation-induced skull base osteonecrosis; diabetes, hypertension, or other systemic diseases; results of nasopharyngeal bacterial culture; and nasopharyngeal tumor recurrence. Univariate and multivariate analyses were performed using the Chi-square test and logistic regression. Afterward, the Kaplan-Meier's method was applied to analyze the survival of patients with nasopharyngeal hemorrhage. RESULTS: Among all patients examined, 64 (11.9%) had nasopharyngeal hemorrhage after radiotherapy. The univariate analysis showed that T-stage (P < 0.01), secondary-course radiotherapy (P < 0.01), radiation-induced skull base osteonecrosis (P < 0.01), nasopharyngeal bacterial culture results (P < 0.01), and nasopharyngeal tumor recurrence (P < 0.01) were associated with nasopharyngeal hemorrhage. Multivariate analysis showed that only radiation-induced skull base osteonecrosis was significantly associated with nasopharyngeal hemorrhage after radiotherapy (odds ratio = 41.83, P = 0.0001). Nevertheless, in patients with internal carotid artery hemorrhage, the survival rate was much lower than that in patients with external carotid artery bleeding. The main cause of death during follow-up was rebleeding. CONCLUSION: The rate of mortality in patients with nasopharyngeal hemorrhage after radiotherapy was high. The presence of radiation-induced skull base osteonecrosis was a decisive factor in these patients. However, after successful rescue, arterial embolization or stent implantation is proposed to prolong survival.