Carotid blowout syndrome (CBS) in head and neck squamous cell carcinoma: Chemoradiation and local recurrence as inductor for carotid artery blowout?

Introduction:

Carotid blowout syndrome (CBS) is a life threatening but rare emergency in head and neck squamous cell carcinoma (HNSCC). Literature lacks longitudinal analysis of a comprehensive HNSCC cohort to identify high risk patients with increased CBS rates with respect to treatment regimens.

Methods:

Between 2001 – 2011, we retrospectively included all HNSCC patients (n = 1,072) treated in our department with subsequent dichotomization due to the event of CBS. Disease related data were analyzed using Chi square, Fisher exact, and student's t-test. Survival rates and prognostic variables were calculated by Kaplan-Meier, log-rank test and subsequently by Cox regression for forward selection.

Results:

A total of 36 patients developed CBS in this period. Patients with CBS had significantly advanced T status (p = 0.001) and UICC-stage (p = 0.004) compared to their unaltered counterparts. Mean and median OS was comparable in both groups after UICC stage IV adjustment, the mean RFS was significantly better in patients without CBS (67 months) when compared with CBS patients (24 months; p < 0.001). Multivariate Cox regression revealed the event of local recurrent disease [HR: 1.86; p < 0.001] and the treatment regime of CRT [HR: 2.17; p < 0.001] as independent risk factor for CBS associated death.

Conclusions:

Advanced T status, C-/RT and tumor recurrency at primary tumor site significantly increase the risk of CBS associated death and serve as predictors to identify high-risk patients for CBS.

Publication History

Publication Date:
23 April 2019 (online)