3625 - Massive Nasal Bleeding in Patients with Nasopharyngeal Carcinoma Received Curative Radiotherapy

H. S. Cheng¹, T. Y. Lin², and J. C. Lin^1,3; ¹Department of Radiation Oncology, Taichung Veterans General Hospital, Taichung, Taiwan, ²Department of Otorhinolaryngology-Head and Neck Surgery, Taichung Veterans General Hospital, Taichung, Taiwan, ³Department of Radiation Oncology, Changhua Christian Hospital, Changhua, Taiwan

Purpose/Objective(s): To investigate the incidence, predictive markers, and survival impact of massive nasal bleeding in nasopharyngeal carcinoma (NPC) patients who received curative radiotherapy (RT) with/without chemotherapy. Materials/

Methods: A total of 1327 patients with previously untreated, biopsy-proven NPC, and no distant metastasis were retrospective reviewed. There are 957 males and 370 females, with a median age of 47 (range 15-85) years. Histologically, 1304 patients (98.3%) exhibited nonkeratinizing carcinoma. Most patients (n=1075, 81.0%) presented with advanced stage III-IV. The initial definitive treatment consisted of RT alone (n=91) or RT combined with concurrent (n=353) or neoadjuvant (n=883) chemotherapy. Fourteen, 1029, and 284 patients finished RT doses of < 70 Gy, 70 Gy, and > 70 Gy. Intensity-modulated radiotherapy was used among 1026 patients (77.3%), and 301 patients (22.7%) received conventional 2D or 3D conformal radiotherapy. We analyzed the occurrence rates of massive nasal bleeding between different characteristics and tried to identify important predictive factors. We compared overall survival between patients with and without massive nasal bleeding by Kaplan-Meier method.
Results: After a medium follow-up of 108 months, 70 patients (5.3%) encountered massive nasal bleeding at intervals ranging from 3 to 191 months after RT. We identified three major risk factors associated with the occurrence of massive bleeding, including advanced T-stage (bleeding rates = 9.0% for T3-4 vs 2.2% for T1-2, p<0.0001), high RT dose (12.3% for > 70 Gy vs 3.4% for ?70 Gy, p<0.0001), and the occurrence of local recurrence (25.0% vs 2.9%, p<0.0001). A risk score in predicting massive bleeding was constructed. The 10-year massive bleeding rate among patients with 0, 1, 2, 3 risk factors were 0.4%, 6.5%, 12.6%, and 54.1%, respectively (p<0.0001). Survival analysis revealed a significant difference between patients with and without massive bleeding (5-year rates, 40.0% vs 80.9%; 10-year rates, 14.0% vs 65.8%, p < 0.0001).
Conclusion: This study found a 5.3% massive bleeding rate for NPC patients after RT. The occurrence of massive bleeding affected overall survival significantly. Advanced T-stage, high RT dose, and the presence of local recurrence were major risk factors in predicting massive bleeding.