Fatal carotid blowout syndrome after BNCT for head and neck cancers.
Boron neutron capture therapy (BNCT) is high linear energy transfer (LET) radiation and tumor-selective radiation that does not cause serious damage to the surrounding normal tissues. BNCT might be effective and safe in patients with inoperable, locally advanced head and neck cancers, even those that recur at previously irradiated sites. However, carotid blowout syndrome (CBS) is a lethal complication resulting from malignant invasion of the carotid artery (CA); thus, the risk of CBS should be carefully assessed in patients with risk factors for CBS after BNCT. Thirty-three patients in our institution who underwent BNCT were analyzed. Two patients developed CBS and experienced widespread skin invasion and recurrence close to the carotid artery after irradiation. Careful attention should be paid to the occurrence of CBS if the tumor is located adjacent to the carotid artery. The presence of skin invasion from recurrent lesions after irradiation is an ominous sign of CBS onset and lethal consequences.
Proton Medical Research Centre, University of Tsukuba, Tennodai 1-1-1, Tsukuba, Ibaraki 305-8575, Japan; Otolaryngology Head and Neck Surgery, Kawasaki Medical School, Kurashiki, Japan. Electronic address: aiteru@med.email.ne.jp.
T
T
Aihara
Departments of Radiation Oncology, Kawasaki Medical School, Kurashiki, Japan.
J
J
Hiratsuka
Proton Medical Research Centre, University of Tsukuba, Tennodai 1-1-1, Tsukuba, Ibaraki 305-8575, Japan.
H
H
Ishikawa
Proton Medical Research Centre, University of Tsukuba, Tennodai 1-1-1, Tsukuba, Ibaraki 305-8575, Japan.
H
H
Kumada
Proton Medical Research Centre, University of Tsukuba, Tennodai 1-1-1, Tsukuba, Ibaraki 305-8575, Japan.
K
K
Ohnishi
Departments of Radiation Oncology, Kawasaki Medical School, Kurashiki, Japan.
N
N
Kamitani
Radiation Oncology Research Laboratory, Research Reactor Institute, Kyoto University, Osaka, Japan.
M
M
Suzuki
Proton Medical Research Centre, University of Tsukuba, Tennodai 1-1-1, Tsukuba, Ibaraki 305-8575, Japan.
H
H
Sakurai
Otolaryngology Head and Neck Surgery, Kawasaki Medical School, Kurashiki, Japan.
T
T
Harada
D016754:Boron Neutron Capture Therapy / Q000009:adverse effects*; D002339:Carotid Arteries / Q000473:pathology*; D017809:Fatal Outcome; D006258:Head and Neck Neoplasms / Q000532:radiotherapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012422:Rupture, Spontaneous / Q000209:etiology*
BNCT; Carotid blowout syndrome; Head and neck cancer; Recurrence after irradiation; Widespread skin invasion