RESULTS

Physical and clinical characteristics of the patients

A total of 17 patients with nasopharyngeal hemorrhage after radiation treatment of NPC were included in this study, and their clinical characteristics are summarized in Table 1. The majority of these patients had stage III or IV NPC, which was classified according to the seventh edition of American Joint Committee on Cancer TNM classification. In the 17 patients, 10 cases received 1 course of radiotherapy, 7 cases received two courses of radiotherapy, and all patients had not undergone surgical resection. Among them, 3 cases were treated by two-dimensional radiotherapy and 14 cases were treated by IMRT. The nasopharynx dose was 68–72 Gy, the cervical metastatic lymph node was 64–70 Gy, the high-risk area was 60–62 Gy, and the low-risk area was 54–56 Gy. 13 (76.5%) presented with extensive erosion and necrosis in the nasopharyngeal tissue, with necrotic tissue located mostly adjacent to the posterior wall. These patients also exhibited extensive skull base destruction and sinusitis according to computed tomography (CT) scan performed at admission (Table 2). Fourteen patients had varying degrees of difficulty in opening their mouths, with an average gap of 2.35 cm and a minimum gap of 0.5 cm. Nasal discharge accompanied with oral or nasal odor was noted in 14 cases about two weeks before the occurrence of nasopharyngeal hemorrhage. Ten patients (58.8%) complained of recurrent headaches, including six cases with occipital pain, 2 cases with frontal pain, and two cases with palatal pain. Also, 6 patients (35.3%) suffered repeated nasal bleeding before nasopharyngeal hemorrhage. Of the 17 patients, 15 (88.2%) had unilateral illness, whereas the other 2 had bilateral hemorrhage (Table 3). The cumulative total blood loss ranged between 300 and 4,000 mL. All the clinical data and results are summarized in Tables 4 and 5.

(To view a larger version of Table 2, please click here.)

(To view a larger version of Table 3, please click here.)

Etiology and Management of Nasopharyngeal Hemorrhage After Radiotherapy for Nasopharyngeal Carcinoma

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