Efficacy of endovascular superselective chemoembolization with HepaSphere 50–100 μm microspheres saturated with cytostatic in stopping nosebleeds in patients with nasopharyngeal cancer

The OBJECTIVE was to show the effectiveness of a new method for stopping nosebleeds in patients with nasopharyngeal cancer using endovascular superselective chemoembolization of the tumor arterial bed with HepaSphere 50–100 μm microspheres saturated with the cytostatic doxorubicin.
METHODS AND MATERIALS. The results of treatment of 94 patients who against the background of progressive growth of nasopharyngeal cancer and ongoing combined treatment in oncology centers experienced nosebleeds are presented. In all these patients, according to the results of examinations in cancer centers, no convincing source of nosebleeds was identified. In the conditions of Polenov Neurosurgical Institute, 94 patients underwent endovascular superselective chemoembolization of the vasculature of nasopharyngeal cancer. The embolizate was a mixture of HepaSphere 50–100 μm microspheres saturated with the cytostatic doxorubicin (50 mg). All patients were included in the study in the absence of contraindications and after signing a voluntary informed consent approved by the ethics committee. The selection of patients was carried out according to the following criteria: thorough morphological verification of the neoplasm; locally advanced process of III and IV stages (T2-4 N0-2M0); no history of other cancers; absence of individual hematogenous metastases; absence of competitive pathology in the stage of decompensation; age was over 18 years old. All patients underwent induction-simultaneous chemoradiotherapy (CRT) with the use of radiation therapy in the usual dose fractionation regimen.
RESULTS. The hemostatic effect was achieved in all 94 patients due to sequential superselective chemoembolization of the vasculature of the tumor itself with embolizate, which was a mixture of HepaSphere 50–100 μm microspheres saturated with the cytostatic doxorubicin (50mg). In the future, nosebleeds in these patients did not occur. The main sources of nosebleeds were the following branches of the external carotid artery: in 46.2 % of cases – the maxillary artery, in 37.6 % – the ascending pharyngeal artery, in 8.6 % – the occipital artery, in 5.4 % – the artery of the carotid node, in 2.2 % – other branches of the external and internal carotid arteries on one side or on both sides.
CONCLUSION. The method of endovascular superselective chemoembolization with doxorubicin of the vasculature of nasopharyngeal cancer complicated by nosebleeds developed and introduced into medical practice was the initial stage of the combined treatment of these neoplasms. A good hemostatic effect was achieved in all 94 patients.

1. Svistov D. V., Kandyba D. V., Savello A. V., Landik S. A., Dolgi V. N. Preoperative embolization of hypervascular neoplasms of the brain and skull base // Collection of lectures on topical issues of neurosurgery; eds by V. E. Parfenova, D. V. Svistova. SPb., 2008:29–96. (In Russ.).

2. Brouzas D., Charakidas A., Androulakis M., Moschos M. Traumatic optic neuropathy after posterior ethmoidal artery ligation for epistaxis // Otolaryngol Head Neck Surg. 2002;(126):323–325.

3. Cherekaev V. A., Golbin D. A., Gasparyan T. G., Shishkina L. V., Tsukanova T. V. Management of craniofacial chondroid tumors // J Craniofac Surg. 2015;26(1):10–18.

4. Cherekaev V. A., Golbin D. A., Kapitanov D. N. et al. Advanced craniofacial juvenile nasopharyngeal angiofibroma. Description of surgical series, case report, and review of literature // Acta Neurochir (Wien). 2011;153(3):499–508.

5. Cruz A. A., Atique J. M., Melo-Filho F. V., Elias J. Jr. Orbital involvement in juvenile nasopharyngeal angiofibroma: prevalence and treatment // Ophth Plast Reconstr Surg. 2004;(4):296–300.

6. GRAY’S Clinical Neuroanatomy. The Anatomic Basis for Clinical Neuroscience / eds by L. Elliott, G. David. Elsevier. 2011:60–61.

7. Garcia-Monaco R., Alvarez H., Rodesch G. Embolization of Vascular Lesions of the Head and Neck // Interventional Neuroradiology. 1993;1–22.

8. Greenberg M. S. Handbook of neurosurgery. 7th ed. New York, Thieme, 2010.

9. Kim J. K., Cho J. H., Lee Y. J., Kim C. H., Bae J. H., Lee J. G., Yoon J. H. Anatomical Variability of the Maxillary Artery. Findings From 100 Asian Cadaveric Dissections // Arch Otolaryngol Head Neck Surg. 2010; 136(8):813–818.

10. Lasjaunias P., Berenstein A. et al. Surgical Neuroangiography: 1. Functional Anatomy of Craniofacial Arteries. Springer-Verlag, 1983.

11. Gruber A., Bavinzski G., Killer M., Richling B. Preoperative embolization of hypervascular skull base tumors // Minim Invasive Neurosurg. 2000;43(2):62–71.

12. Harbaugh R., Shaffrey C. I., Couldwell W. T., Berger M. S. et al. Neurosurgery Knowledge Update A Comprehensive Review. 1st ed. New York, Thieme. 2015:31–39;887–893.

13. Klurfan P., Lee S. K. Technical and Anatomical Considerations of the External Carotid System // Medical Radiology. 2006;235–245.

14. Rhoton A. L. Rhoton’s Cranial Anatomy and Surgical Approaches. 1st ed. Lippincott Williams and Wilkins. 2002;51:291–293.

15. Arustamyan S. R., Konovalov A. N., Makhmudov U. B., Shimansky V. N., Tanyashin S. V., Edneva Ya. N., Dedegkaev A. V. Preoperative embolization of the internal carotid artery in the surgical treatment of meningioma of the base of the anterior and middle cranial fossae // Zhurnal Voprosy Neirokhirurgii Imeni N. N. Burdenko. 2003;(4):37–39. (In Russ.).

16. Arustamyan S. R., Lubnin A. Yu. Vessel embolization of extra-intracranial tumors // Zhurnal Voprosy Neirokhirurgii Imeni N. N. Burdenko. 2002;(3):30–34. (In Russ.).

17. Pronin I. N., Fadeeva L. M., Zakharova N. E., Dolgushin M. B., Kornienko V. N. Perfusion CT: a study of cerebral hemodynamics in the norm // J. Med. visualization. 2007;(3):8–12. (In Russ.).