LXXIV Irradiation Injury to Elastic Arteries in the Course of Treatment for Neoplastic Disease

Autopsies were performed on 11 patients who died of massive hemorrhage due to rupture of large elastic arteries following radiotherapy for neoplastic disease. Five had ruptured aortas and 4 died immediately following or during the course of Co60 irradiation for unresectable carcinoma of the middle third of the esophagus. The dosage in 3 was approximates 5000 r, delivered to the tumor in a period of 41 to 47 days. In another, the aorta ruptured during treatment; the patient received 1050 r in 10 days through posterior and arterior fields measuring 5 x 14 cm. Six patients who received x-ray, Ra, or Co therapy for cervical metastases and were later subjected to a radical neck dissection had a ruptured carotid artery, 8 to 34 days after the operation. Macroscopic changes in the arteries were sharply limited to the vessels directly in the field of radiation. A very consistent common denominator was evident in the cases of malignancy treated with irradiation. All had salivary fistulas or infection in the irradiated areas. All 6 cases subjected to radical neck dissection had necrosis of the skin flaps and 5 had salivary fistulae. It is therefore recommended that all patients subjected to combined head andmore » neck operation, after pre-operative irradiation of the neck, be closely followed during the first postoperative month, especially if they develop necrosis of skin flaps and salivary fistulae. By this precaution, radioinduced rupture of the carotid artery may be seen early and corrected by emergency surgery.« less