Hemorrhagic complications in the treatment of laryngopharyngeal cancer stage III–IV in patients of the Altai Territory

Introduction. Laryngopharyngeal cancer is one of the most common head and neck cancers and is a socially significant pathology due to development of aphonia, dysphagia, and high rate of deaths and unfavorable outcomes. Currently, treatment of this pathology and fight against complications remain significant problems. The higher the disease stage, the higher mortality. According to the statistical data, the majority of patients with stage III–IV laryngopharyngeal cancer die in the first year after diagnosis due to severe adverse events such as laryngeal stenosis, dysphagia with subsequent dystrophia, as well as hemorrhages from vessel erosion in the larynx or tumor decay. If laryngeal stenosis or dysphagia are not managed by stoma, hemorrhage due to vessel erosion and diffuse bleeding from the pharynx can cause fatal outcomes.

Aim. To study the rate and type of complications, outcomes in patient with stage III–IV laryngopharyngeal cancer in the first year during induction chemotherapy.

Materials and methods. Data of 69 patients with stage III–IV laryngopharyngeal cancer who received comprehensive treatment between June of 2022 and July of 2024 at the Altai Regional Oncological Dispensary (Barnaul) were analyzed. The study group included 7 patients who developed hemorrhage during 1 course of induction chemotherapy. The comparison group included 62 patients without this complication. Risk of thromboembolic complications per the Khorana scale was low or intermediate: 1–2 points. Risk of hemorrhage per the American College of Chest Physicians (AССP) scale 2016 in the total group (n = 69; 100 %) was high: 4–8 points. The main risk factors, methods and long-term treatment results, as well of causes of death and recurrence-free survival after treatment completion 1 year later were analyzed. The type and rate of hemorrhages and their role in deaths, adverse event prevention measures were evaluated.

Results. In 7 (10.1 %) of 69 patients, hemorrhage developed after 1 course of chemotherapy (study group). Two significant risk factors associated with hemorrhagic complications were identified: hemoptysis at diagnosis and presence of an ulcerative defect in the pharynx which increased the risk of this complication 27.8- and 25-fold, respectively. In 3 patients of the study group, diffuse hemorrhage from the tumor of volume 150 mL was observed. In the other 4 patients, profuse bleeding of volume up to 500 mL developed. Two (28.6 %) patients of the study group were at the remission stage. Deaths during treatment were reported in 5 (71.4 %) patients: they occurred 1–6 months after treatment completion. In the comparison group, 15 (24.2 %) patients were in remission, 2 (3.2 %) of which received treatment due to disease progression. During the first year after treatment completion, 41 (66.1 %) patients died. Survival of 3 (4.8 %) patients was above 12 months: 13, 14 and 15 months; 1 (1.6 %) patient died 19 months after therapy completion.

Conclusion. In patients with stage III–IV laryngopharyngeal cancer, both the risk of venous thromboembolic complications (per the Khorana scale) and the risk of hemorrhages (per the АССР 2016 scale) should be determined. Hemorrhagic complications develop in 10.1 % of cases. Additionally, significant factors of bleeding from the pharynx are hemoptysis at diagnosis and presence of an ulcerative defect in the pharynx. In every case of bleeding from the tumor, tumor site and blood loss volume should be takin into account. Diffuse bleeding should be managed by short courses of tranexamic acid (for 3 days). Patients with profuse ulcerative hemorrhage require ligation of the external carotid artery on the affected side.