Carotid blowout in a patient with nasopharyngeal carcinoma treated with SBRT re-irradiation for local recurrence using twice weekly treatment

Neil M Woody; Aliye Bricker; Nikhil Joshi; Sara J Zakem; Matthew D Greer; Diana Mattson; Shlomo A Koyfman

Carotid blowout in a patient with nasopharyngeal carcinoma treated with SBRT re-irradiation for local recurrence using twice weekly treatment

J Radiosurg SBRT. 2015;3(4):325-329.

Authors

Neil M Woody¹, Aliye Bricker², Nikhil Joshi¹, Sara J Zakem³, Matthew D Greer⁴, Diana Mattson⁵, Shlomo A Koyfman¹

Affiliations

¹ Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio, USA.
² Department of Diagnostic Radiology, Cleveland Clinic, Cleveland, Ohio, USA.
³ Case Western Reserve University School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA.
⁴ Cleveland Clinic Lerner College of Medicine, Case Western Reserve University School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA.
⁵ Department of Radiation Oncology, University Hospitals Case Medical Center, Cleveland, Ohio, USA.

PMID: 29296415
PMCID: PMC5675500

Abstract

We present the case of a patient undergoing reirradiation for a T4 nasopharyngeal tumor 1 year after his initial radiation, treated with SBRT to a moderate dose with twice weekly fractionation. Despite the measures of caution employed, the patient had a fatal carotid blowout at 7 months following SBRT. This suggests that spacing apart fractions of SBRT alone may not be sufficient to obviate the risk of carotid blowout syndrome and other risk factors and interventions should be considered.

Keywords: SBRT; carotid blowout; head and neck; nasopharynx; re-irradiation.