title: Postirradiated carotid blowout syndrome in patients with nasopharyngeal carcinoma: a case-control study.
abstract: BACKGROUND
  Carotid blowout syndrome is one of the most devastating complications of nasopharyngeal carcinoma (NPC) therapy.
  
  
  METHODS
  A retrospective review was conducted from January 2004 to April 2013. Thirty-one patients with carotid blowout syndrome were enrolled and a case control study was conducted to analyze the risk factors.
  
  
  RESULTS
  When a comparison was made between the carotid blowout syndrome and matched non-bleeding group, there was a significantly higher local recurrence rate and prevalence of skull base osteoradionecrosis (ORN) in the carotid blowout syndrome group compared to those of the control group (both p < .001). The hazard ratio of carotid blowout syndrome was 3.599 between patients with or without reirradiation (95% confidence interval, 1.465-8.839; p = .005, adjusted for nasopharyngectomy and chemotherapy) using a Cox proportional hazard model.
  
  
  CONCLUSIONS
  Reirradiation and skull base ORN are strong predisposing factors for carotid blowout syndrome, and therefore they should be mentioned in the informed consent form before treatment.
authors.affiliation: Department of Otolaryngology, Taichung Veterans General Hospital, Taichung, Taiwan.
authors.forename: Kun-Chih
authors.initials: KC
authors.lastname: Chen
authors.affiliation: Department of Otolaryngology, Taichung Veterans General Hospital, Taichung, Taiwan.
authors.forename: Ting-Ting
authors.initials: TT
authors.lastname: Yen
authors.affiliation: Department of Otolaryngology, Taichung Veterans General Hospital, Taichung, Taiwan.
authors.forename: Yi-Ling
authors.initials: YL
authors.lastname: Hsieh
authors.affiliation: Department of Radiology, Taichung Veterans General Hospital, Taichung, Taiwan.
authors.forename: Hung-Chieh
authors.initials: HC
authors.lastname: Chen
authors.affiliation: Department of Otolaryngology, Taichung Veterans General Hospital, Taichung, Taiwan.|School of Medicine, Chung Shan Medical University, Taichung, Taiwan.
authors.forename: Rong-San
authors.initials: RS
authors.lastname: Jiang
authors.affiliation: Department of Radiology, Taichung Veterans General Hospital, Taichung, Taiwan.
authors.forename: Wen-Hsien
authors.initials: WH
authors.lastname: Chen
authors.affiliation: Department of Otolaryngology, Taichung Veterans General Hospital, Taichung, Taiwan.|School of Medicine, Chung Shan Medical University, Taichung, Taiwan.|Department of Medicine, National Yang-Ming Medical University, Taipei, Taiwan.
authors.forename: Kai-Li
authors.initials: KL
authors.lastname: Liang
mesh_terms: D000328:Adult; D000368:Aged; D001918:Brachytherapy / Q000009:adverse effects* / Q000379:methods; D002277:Carcinoma; D002340:Carotid Artery Diseases / Q000209:etiology* / Q000401:mortality / Q000503:physiopathology; D016022:Case-Control Studies; D005260:Female; D006470:Hemorrhage / Q000209:etiology* / Q000401:mortality / Q000503:physiopathology; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D000077274:Nasopharyngeal Carcinoma; D009303:Nasopharyngeal Neoplasms / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D010025:Osteoradionecrosis / Q000401:mortality / Q000503:physiopathology; D011379:Prognosis; D016016:Proportional Hazards Models; D011832:Radiation Injuries / Q000175:diagnosis / Q000401:mortality*; D012016:Reference Values; D012189:Retrospective Studies; D018570:Risk Assessment; D012422:Rupture, Spontaneous; D016019:Survival Analysis; D013577:Syndrome
keywords: carotid blowout syndrome; chemotherapy; nasopharyngeal carcinoma; osteoradionecrosis; radiotherapy