Predictors of survival following carotid blowout syndrome. (February 2022)

• Record Type: Journal Article
• Authors: Silverman, Dustin A.; Parikh, Anuraag S.; Liu, Kevin; Zhan, Kevin Y.; Nimjee, Shahid M.; Powers, Ciaran J.; Youssef, Patrick; Rocco, James W.; VanKoevering, Kyle K.; Kang, Stephen Y.; Old, Matthew O.; Seim, Nolan B.
• Is Part Of: Oral oncology. Volume 125(2022)
• Publication Date: 2022-02
• Subjects: Carotid blowout syndrome -- Head and neck cancer -- Time to intervention -- Survival -- Covered stents -- Embolization; Mouth -- Cancer -- Periodicals; Mouth -- Tumors -- Periodicals; Mouth Diseases -- Periodicals; Mouth Neoplasms -- Periodicals; Bouche -- Cancer -- Périodiques; Bouche -- Tumeurs -- Périodiques; Tumeurs -- Périodiques; Electronic journals; 616.9943105
• DOI: 10.1016/j.oraloncology.2022.105723
• Languages: English
• ISSNs: 1368-8375

Abstract

Highlights: Following CBS, 30-day and 1-year OS rates are 70.1% and 32.0%, respectively. Predictors of survival: oropharyngeal/active tumors, ICA/CCA rupture, acute bleeds. 15.6% of patients suffered complications post-CBS. Stroke occurred in 1 patient. Treatment algorithm promoting physician-to-physician discussion is unique. Prompt intervention at experienced treatment centers may improve outcomes after CBS. Abstract: Objectives: Carotid blowout syndrome (CBS) is a rare, life-threatening complication for patients with head and neck cancer (HNC). The primary objective was to identify factors associated with survival following CBS. Materials and Methods: A retrospective analysis of HNC patients treated at a single tertiary care hospital with CBS between 2016 and 2020 was performed. A multivariate Cox proportional-hazards model identified independent predictors of survival. A p value of <0.05 was considered significant. Kaplan-Meier survival analysis was performed. Results: 45 patients were identified. The majority were male (80.0%) with a mean age of 64 years at time of blowout. Oropharynx was the most common primary site (48.9%) and 73.3% of patients had stage IV disease. 35 (77.7%) patients had active tumor at time of CBS. 93.3% of patients previously received RT with a mean total dose of 62.5 ± 14.8 Gy. Threatened/type I, impending/type II, and acute/type III CBS occurred in 6.7%, 62.2%, and 31.1% of cases, respectively. Patients underwent either embolization (80.0%) or endovascular stent placement (20.0%). The 30-day and 1-year OS rates were 70.1% and 32.0%, respectively. Primary oropharyngeal tumors (adjusted hazard ratio [aHR], 4.31 [1.30–15.15 95% confidence interval]), active tumor at time of CBS (aHR 8.21 [2.10–54.95]), ICA or CCA rupture (aHR 5.81 [1.63–21.50]), and acute/type III CBS (aHR 2.98 [1.08–7.98]) were independent predictors of survival. Conclusion: Primary oropharyngeal tumors, active tumor at time of CBS, ICA or CCA rupture, and acute/type III hemorrhage were independent predictors of survival. Multidisciplinary management and prompt, protocol-directed intervention may improve outcomes following CBS.