Department of Dental Surgery, The University of Hong Kong-Shenzhen Hospital, Shenzhen, Guangdong, China; Department of Clinical Oncology, Shenzhen Key Laboratory for Cancer Metastasis and Personalized Therapy, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China.
Department of Surgery, Division of Otolaryngology, Head and Neck Surgery, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China; Department of Clinical Oncology, Shenzhen Key Laboratory for Cancer Metastasis and Personalized Therapy, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China.
Radiother Oncol. 2024 Nov;200:110502. doi: 10.1016/j.radonc.2024.110502. Epub 2024 Aug 26.
Carotid blowout syndrome (CBS) is a rare but potentially life-threatening complication that can occur in patients with head and neck cancer (HNC), especially with a history of radiotherapy. This study aimed to review and initially compare managements for post-radiation CBS in patients with HNC.
A systematic review of published studies was performed. Information including management, survival, and complication were collected.
A total of 39 articles and 917 cases were included in the systematic review. The interval between radiation therapy and CBS ranged from 1.2 years to 17.8 years. The managements of CBS included embolization, stent, bypass surgery, surgical ligation, electrocoagulation, flap coverage, arterial repair, and nasopharyngeal packing. The cumulative 30-day, 1-year, and 2-year overall survival rates were 85.2 %, 48.9 %, and 37.0 %, respectively, with a median survival time of 11.3 months. Disease progression and rebleeding were the most common death causes. The lowest rebleeding rate and neurologic complications rate were presented in cases receiving bypass surgery at 1.4 % and 10.8 %, respectively. The highest rebleeding rate of 35.6 % was showed in cases underwent stent, and the highest neurologic complications rate of 32.0 % was showed in cases underwent ligation.
Post-radiation CBS in patients with HNC had a low survival rate and high complication rate. Rebleeding and neurologic complication were common complications. Endovascular embolization and stent were the mainstream management, and bypass surgery presented a promising outcome in survival and complication for selected patients.
颈动脉破裂综合征（CBS）是一种罕见但潜在危及生命的并发症，可发生于头颈部癌症（HNC）患者，尤其是有放疗史的患者。本研究旨在回顾和初步比较 HNC 患者放疗后 CBS 的治疗方法。
对已发表的研究进行系统回顾。收集管理、生存和并发症等信息。
共纳入 39 篇文章和 917 例病例。放疗与 CBS 之间的时间间隔为 1.2 年至 17.8 年。CBS 的治疗方法包括栓塞、支架、旁路手术、结扎、电凝、皮瓣覆盖、动脉修复和鼻咽填塞。30 天、1 年和 2 年的总生存率分别为 85.2%、48.9%和 37.0%，中位生存时间为 11.3 个月。疾病进展和再出血是最常见的死亡原因。接受旁路手术的患者再出血率和神经并发症率最低，分别为 1.4%和 10.8%。支架治疗的再出血率最高，为 35.6%，结扎治疗的神经并发症率最高，为 32.0%。
HNC 患者放疗后 CBS 的生存率低，并发症发生率高。再出血和神经并发症是常见并发症。血管内栓塞和支架是主流治疗方法，旁路手术对选择的患者在生存和并发症方面表现出较好的结果。
