Recurrent small bleeds can sometimes be managed by CO2 laser. Only vessels smaller than 0.5 mm will respond to such treatment. Slightly larger vessels will coagulate in response to Nd: YAG laser treatment. Should active resuscitation be appropriate, volume replacement with crystalloids and blood will be necessary.
Radiation treatment is the mainstay of palliative therapy in these cases: it often stops bleeding within a matter of days. Occasional patients presenting with haemodynamically significant haemorrhage may be candidates for more aggressive therapy. Even patients with T3/T4 lesions can attain a five-year survival rate of up to 25%.
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