Assessment of Prophylactic Internal Carotid Artery Management in Postradiation Nasopharyngeal Necrosis Patients

医学 颈内动脉 鼻咽癌 列线图 比例危险模型 回顾性队列研究 闭塞 磁共振成像 外科 放射科 坏死 内科学 放射治疗
作者
Yong‐Long Liu,Kai Wen,Weijing Zhang,Yan‐Feng Ouyang,Jin‐Hua Chen,Yang‐Kui Gu,Qi Mei,Ming‐Yuan Chen,Yi‐Jun Hua,Jian Li
出处
期刊:Otolaryngology-Head and Neck Surgery [Wiley]
卷期号:170 (2): 447-456
标识
DOI:10.1002/ohn.615
摘要

Abstract Objective Postradiation nasopharyngeal necrosis (PRNN) frequently develops after second‐course radiotherapy for nasopharyngeal carcinoma (NPC). PRNN can lead to internal carotid artery (ICA) massive hemorrhage due to ICA rupture, resulting in sudden death. This study aims to explore the pretreatment of the ICA to prevent fatal massive hemorrhage in PRNN patients. Study Design Retrospective cohort study. Setting Sun Yat‐sen University Cancer Center. Methods Patients diagnosed with NPC and PRNN from January 2010 to September 2022 were included. The Cox proportional hazards regression analysis was performed to analyze risk factors for massive hemorrhage and survival. A nomogram was developed to integrate prognostic models and perform parameter calibration. Results Two hundred and fifty‐four PRNN patients were included in this study. Prophylactic ICA occlusion significantly reduced the risk of ICA hemorrhage compared to no prophylactic ICA occlusion (3.6% vs 40.6%, P < .001). Surgical repair on necrosis significantly prevented hemorrhage and improved survival. The nomogram, incorporating the above 2 factors and the nearest distance from necrosis to ICA ≤ 3 mm, exhibited excellent discriminative ability for hemorrhage. We identified 3 high‐risk factors that indicate the need for prophylactic ICA management in PRNN patients: (1) exposure of ICA by rhinoscopy; (2) signs of ICA erosion on MRA scanning; (3) the depth of soft tissue coverage surrounding the ICA wall within the necrotic cavity is less than 3 mm on magnetic resonance imaging. Conclusion We have identified 3 high‐risk factors for PRNN patients that necessitate prophylactic ICA management. These findings are expected to contribute to improving the quality of life and overall survival of PRNN patients.
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