Analysis of the risk of death and clinical management for nasal or nasopharyngeal bleeding occurring after radiotherapy for nasopharyngeal carcinoma.

Objective: To retrospectively analyze the risk factors for death in patients with nasal or nasopharyngeal bleeding after radiotherapy for nasopharyngeal carcinoma, and to explore clinical management strategies for the disease.

Methods: This was a retrospective case-control study. The clinical data from patients diagnosed with nasopharyngeal or nasopharyngeal hemorrhage after radiotherapy for nasopharyngeal carcinoma at the First Affiliated Hospital of Guangxi Medical University between January 2006 and October 2021 were retrospectively analyzed. Chi-square analysis and odds ratio (OR) calculation were performed to evaluate the death risk factors associated with the disease. And binary logistic regression analysis was used to detect some independent factors in this study.

Results: Of the 85 patients, 71 (83.5%) were male and 14 (14.5%) were female; 11 patients died (mortality rate: 12.9%), of which 9 died of asphyxia (7 with hemorrhagic shock), 1 died of multiorgan failure and acute respiratory distress syndrome, and 1 died of left cerebellar infarction. Nine potential mortality factors were evaluated; age, sex, nasal tamponade, and open mouth restriction were not significantly associated with death (P > 0.5); absence of immediate airway protection (in the major bleeding group) , absence of angiography, skull base destruction, major bleeding, and re-irradiation were significantly associated with death (P < 0.05). Among these factors, binary logistic regression model showed increased risk of death in patients without immediate airway protection (OR=18.14,95%CI:1.48-221.64), in patients without angiography (OR=14.65, 95%CI:2.37-90.73), and in those with re-irradiation (OR=13.23,95%CI:1.004-174.23).

Conclusion: Binary logistic regression model shows that absence of immediate airway protection, absence of angiography, and re-irradiation are independent risk factors for death. The mortality rate due to bleeding after radiotherapy for nasopharyngeal carcinoma is high, and active management and intervention to address the risk factors for death is key to treat the disease and save patients' lives. At the same time, we need to consider the patient's causative state of bleeding.