title: Transcutaneous arterial embolization to control massive tumor bleeding in head and neck cancer: 63 patients' experiences from a single medical center.
abstract: BACKGROUND
  Massive tumor bleeding is a life-threatening complication in patients with head and neck cancer (HNC). Tumor hemorrhage is usually hard to localize, and medical management is often ineffective. Arterial angiography is used to visualize the source of bleeding, and concurrent transcutaneous arterial embolization (TAE) can be done to stop bleeding in some patients. We analyzed the outcome of TAE in HNC patients with massive bleeding at our institution.
  
  
  METHODS
  We retrospectively reviewed 93 angiographic procedures in 63 HNC patients. Factors potentially related to post-hemorrhagic survival were evaluated, including tumor stage (T, N, M), tumor type, previous curative-intent surgery, previous chemotherapy, previous radiotherapy, angiographic findings, the presence of embolization, and the embolization methods.
  
  
  RESULTS
  A total 56 TAEs were done in 93 angiographic procedures in 63 HNC patients. The overall median post-hemorrhagic survival after angiography was 16 days (range 0-644 days). Median post-hemorrhagic survival for patients receiving TAE was 26 days (range 0-644 days), while patients who received angiography alone survived 8 days (range 0-144 days; p = 0.008). No factors other than TAE predicted post-hemorrhagic survival, and there were no major adverse events after TAE.
  
  
  CONCLUSIONS
  In our hands, TAE was associated with a low incidence of toxicities commonly attributable to the procedure such as stroke. Patients who were able to undergo TAE lived longer than those who were not candidates for the procedure.
authors.affiliation: Division of Hematology/Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
authors.forename: Wen-Chi
authors.initials: WC
authors.lastname: Chou
authors.forename: Chang-Hsien
authors.initials: CH
authors.lastname: Lu
authors.forename: Gigin
authors.initials: G
authors.lastname: Lin
authors.forename: Yu-Shin
authors.initials: YS
authors.lastname: Hong
authors.forename: Ping-Tsung
authors.initials: PT
authors.lastname: Chen
authors.forename: Hung-Chih
authors.initials: HC
authors.lastname: Hsu
authors.forename: Jen-Shi
authors.initials: JS
authors.lastname: Chen
authors.forename: Kun-Yun
authors.initials: KY
authors.lastname: Yeh
authors.forename: Hung-Ming
authors.initials: HM
authors.lastname: Wang
authors.forename: Chuang-Chi
authors.initials: CC
authors.lastname: Liaw
mesh_terms: D000046:Academic Medical Centers; D000328:Adult; D000368:Aged; D000792:Angiography; D004621:Embolization, Therapeutic; D005260:Female; D006258:Head and Neck Neoplasms / Q000097:blood / Q000503:physiopathology*; D006470:Hemorrhage / Q000517:prevention & control*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000097:blood / Q000473:pathology*; D012189:Retrospective Studies; D013624:Taiwan