Efficacy of palliative radiotherapy for gastric bleeding in patients with unresectable advanced gastric cancer: a retrospective cohort study

Abstract

BackgroundBleeding negatively impacts quality of life in patients with unresectable advanced gastric cancer and has the potential to be lethal. When blood transfusion and endoscopic hemostasis are unsuccessful to stop bleeding, radiation to stomach is selected in patients with unsuitable condition for surgery. We performed a retrospective cohort study to clarify the utility of radiotherapy in treating gastric bleeding, particularly for patients with limited life expectancy.MethodsWe evaluated the efficacy and safety of palliative radiotherapy in patients with advanced gastric cancer between January 2007 and December 2012 in Aichi Cancer Center Hospital. All patients had gastric bleeding requiring blood transfusion. We defined hemostasis as an increase in hemoglobin level to more than 7.0 g/dL together with the cessation of melena or hematemesis for at least 1 week.ResultsDuring the study period, 313 advanced gastric cancer patients treated in our institution. Of these 17 patients received gastric radiotherapy to stop bleeding. Two patients were excluded from analysis due to combined treatment of intravascular embolization. Eleven out of 15 patients (73 %) had undergone two or more previous chemotherapy regimens. Ten patients (67 %) had an Eastern Cooperative Oncology Group performance status of 3 and 14 patients (93 %) were in palliative prognostic index group B or C. The median total planned radiation dose was 30 Gy in 10 fractions. At a median interval of 2 days after initiation of radiotherapy, 11 patients (73 %) achieved hemostasis; rebleeding was observed in four patients (36 %). The median hemoglobin level before radiotherapy was significantly increased from 6.0 to 9.0 g/dL (p < 0.0001). The median volume of red blood cell transfusion was significantly decreased from 1120 to 280 mL (p = 0.007). The median rebleeding-free survival interval was 27 days, with a median overall survival of 63 days. The cause of death was bleeding in 1 patient (7 %) and cancer progression without bleeding in 12 patients (80 %). There were no severe adverse events attributable to radiotherapy.ConclusionsPalliative radiotherapy for gastric bleeding achieves hemostasis within a short time frame. This appears to be a useful treatment option, especially for patients with end-stage, unresectable advanced gastric cancer.

Gastric Cancer, Version 3.2016, NCCN Clinical Practice Guidelines in Oncology

“…External beam RT and endoscopic treatment have been shown to effectively manage acute and chronic blood loss from GI bleeding. 100,101 Proton pump inhibitors can be prescribed to reduce the risk of bleeding from gastric cancer; however, no definite data are available supporting their use at this time. Obstruction: The primary goals of palliation for patients with malignant gastric obstruction are to reduce nausea and vomiting and, when possible, allow resumption of an oral diet.…”

Improvement of Chronic Bleeding in the Patient with Unresectable Advanced Gastric Cancer Using the Decoction of - a Case Report

“…9) Especially palliative radiotherapy was generally performed to unresectable advanced gastric cancer bleeding. 5) This patient visited hospital because of poor oral intake and melena. One year ago, he had been initially diagnosed advanced gastric cancer of clinical stage T3N+ (Borrman type III).…”

“…4) Especially palliative radiotherapy is used in unresectable advanced gastric cancer. 5) As a systemic intervention, vitamin K, vasopressin, somatostatin analogues, antifibrinolytic agents like tranexamic acid are also used. 4) Red blood cell (RBC) transfusion is also needed if hemoglobin level is less than 7g/dl.…”

Tatalaksana Radioterapi pada Kekambuhan Lokal Kanker Ovarium Clear Cell

“…Relaps dapat terjadi pasca pembedahan sitoreduksi atau pada waktu pemberian kemoterapi pada kanker ovarium yang memiliki sifat platinum resisten 15,16 . 17,18 . Perdarahan diatasi dengan radiasi dan pemberian tranfusi PRC untuk mengatasi anemia yang dapat memperberat hipoksia pada lingkungan mikro tumor 13,19 .…”