Catastrophic Hemorrhage After Chemoradiation for Advanced Stage Oropharyngeal Carcinoma: A Case Series

We have seen several incidences of catastrophic bleeding in patients with advanced oropharyngeal squamous cell carcinoma treated nonoperatively. Aside from advanced disease, these patients have not had traditional risk factors for major hemorrhage.

Retrospective chart review.

Patients treated nonoperatively for oropharyngeal squamous cell carcinoma were compared to determine characteristics that may predisposed to bleeding. Five patients with bleeding were identified and compared with a cohort of stage- and treatment-matched patients without bleeding. Blinded imaging review was performed to characterize the tumor site and its relationship to vasculature using standardized systems.

Comparing the bleeder versus nonbleeder groups pre-treatment, the bleeder group had larger tumors (15.4 vs. 8.3 cm² ), greater rates of parapharyngeal fat effacement (80% vs. 20%), and always involved the facial artery. Post-treatment, endophytic ulcerated tumor beds occurred in 100% of bleeders versus 0% of nonbleeders.

Catastrophic oropharyngeal bleeding may be encountered after cytoreductive therapy. Large deeply invasive tumors seem to set the necessary circumstances. Rapid vascular control with interventional radiology has been largely effective therapy.

3 Laryngoscope, 131:1049-1052, 2021.