Repeated massive epistaxis after re‑irradiation in recurrent nasopharyngeal carcinoma

With the development of radiotherapy technology and comprehensive treatment with chemotherapy, great progress has been made in the treatment of nasopharyngeal carcinoma (NPC) [1]. Unfortunately, some patients still suffer from local recurrence, the main treatment for which is still radiotherapy [2–4]. Although the incidence of massive epistaxis after re‑irradiation is not high [5], it is a challenging situation that clinicians have to face because improper treatment may lead to death. This article reports one case of recurrent attacks of massive epistaxis after radiotherapy for locally recurrent NPC.
A 50-year-old man, diagnosed in August 2006 with low-differentiated NPC T2N2M0 (according to the Chinese 1992 staging system [6]), underwent three-dimensional conformal radiotherapy at a total dose of 70 Gy/35 fx and received concurrent and adjuvant chemotherapy (using the cisplatin-fluorouracil, also known as the PF, regimen). After five cycles of chemotherapy, evaluation of treatment response demonstrated complete regression. Regular magnetic resonance imaging (MRI) follow-up was provided. The patient came to our hospital again in February 2011 because of tongue movement impairment, which was diagnosed as a local recurrence in the right parapharyngeal tissue by MRI and positron emission tomography (PET)-computed tomography (CT) examination (Fig. 1). Intensity-modulated radiation therapy with a total dose of 70 Gy/35 fx was applied to the recurrent lesion, during and after which the patient again received four cycles of chemotherapy (using the paclitaxel-cisplatin, also known as the TP, regimen).
The patient was admitted to hospital for the third time in June 2011 because of headache and right facial pain and swelling, with an odorous exhalation from the nose and mouth. The nasopharyngeal MRI examination showed a necrotic change in the right parapharyngeal tissue, with inclusion of the internal jugular artery and vein, the external jugular artery and vein, and the lingual artery and vein. The necrotic tissue extended from the nasopharynx to the oropharynx (Fig. 2). After examination, it was considered septic abscess formation surrounding the right carotid sheath due to ulceration and necrosis of the nasopharyngeal mucus after re‑irradiation. Thus, antibiotics and cortisol were given.
The patient presented with epistaxis of about 20 ml on the second day of hospitalization, which ceased spontaneously without special treatment. No bleeding site...


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