Risk of Carotid Blowout After Reirradiation of the Head and Neck: A Systematic Review

Journal Article · Thu Mar 01 04:00:00 EST 2012 · International Journal of Radiation Oncology, Biology and Physics

DOI:https://doi.org/10.1016/J.IJROBP.2010.08.029· OSTI ID:22056091

Moore, Michael G ^[1]; Johnstone, Peter A.S. ^[2]

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1. Department of Otolaryngology/Head and Neck Surgery, Indiana University School of Medicine, Indianapolis, IN (United States)
2. Indiana University Health Proton Therapy Center, Bloomington, IN (United States)

Purpose: Carotid blowout (CB) is a rare but frequently fatal complication of head-and-neck (H and N) cancer or its treatment. We sought to determine the reported rate of CB in patients receiving salvage reirradiation for H and N cancer. Methods and Materials: A literature search identified 27 published articles on H and N reirradiation involving 1554 patients, and a pooled analysis was performed to determine the rate of CB. Treatment parameters, including prior radiation dose, interval from prior radiation, dose and fractionation of reirradiation, use of salvage surgery, and chemotherapy, were abstracted and summarized. The cumulative risk of CB was compared between groups using Fisher's exact test. Results: Among 1554 patients receiving salvage H and N reirradiation, there were 41 reported CBs, for a rate of 2.6%; 76% were fatal. In patients treated in a continuous course with 1.8-2-Gy daily fractions or 1.2-Gy twice-daily fractions, 36% of whom received concurrent chemotherapy, the rate of CB was 1.3%, compared with 4.5% in patients treated with 1.5 Gy twice daily in alternating weeks or with delayed accelerated hyperfractionation, all of whom received concurrent chemotherapy (p = 0.002). There was no statistically significant difference in the rate of CB between patients treated with or without concurrent chemotherapy, or between patients treated with or without salvage surgery before reirradiation. Conclusion: Carotid blowout is an infrequent but serious complication of salvage reirradiation for H and N cancer. The rate of CB was lower among patients treated with conventional or hyperfractionated schedules compared with regimens of accelerated hyperfractionation, though heterogeneous patient populations and treatment parameters preclude definite conclusions. Given the high mortality rate of CB, discussion of the risk of CB is an important component of informed consent for salvage reirradiation.

• OSTI ID: 22056091
• Journal Information: International Journal of Radiation Oncology, Biology and Physics, Journal Name: International Journal of Radiation Oncology, Biology and Physics Journal Issue: 3 Vol. 82; ISSN IOBPD3; ISSN 0360-3016
• Country of Publication: United States
• Language: English

Related Subjects

62 RADIOLOGY AND NUCLEAR MEDICINE
BLOWOUTS
CHEMOTHERAPY
FRACTIONATION
HAZARDS
HEAD
MORTALITY
NECK
NEOPLASMS
PATIENTS
RADIATION DOSES
SURGERY