Hemostatic radiotherapy for inoperable gastric cancer: a pilot study

Abstract

Objective: Standard treatment for progressive gastric cancer with bleeding includes hemostatic radiotherapy (RT); however, the only prospective study using a fixed dose with fractions during hemostatic RT did not introduce re-irradiation. Therefore, we determined the utility of RT including re-irradiation for gastric cancer. Methods: In this study, 31 patients with gastric cancer and bleeding were treated with an initial dose of 20 Gy/5 fractions for the whole stomach and a salvage dose of 15 Gy/5 fractions for the partial stomach. Patients achieving hemostasis, defined as a stable hemoglobin level within 30 days following irradiation, were considered responders, whereas those with no cessation of bleeding and those with re-bleeding within 30 days of irradiation were considered non-responders. We evaluated response rate, disease-free survival, overall survival (OS), re-irradiation, and adverse events (AEs). Results: The response rate of initial RT was 80% (25/31). 6 of the 25 patients underwent re-irradiation, and all 6 were responders (100%). The median OS was significantly different among the entire cohort and one-time irradiation and re-irradiation groups (91, 76, and 112 days, respectively). No AEs of grade ≥3 were observed. Initial low-dose RT followed by reirradiation was effective in reducing AEs and did not cause any further AEs. Conclusion: Hemostatic RT was an effective approach with low toxicity, and re-irradiation was effective and tolerable, with no patients developing severe AEs. Further, randomized controlled studies are warranted to determine the ideal dose and number of fractions for initial RT in patients with gastric cancer and bleeding. Advances in knowledge: In this prospective study on hemostatic radiotherapy for gastric cancer, the response rate was 80% using a fixed dose of 20 Gy/5 fractions and the salvage dose of 15 Gy for re-bleeding was effective. Future comparative studies should include other doses with 20 Gy as a control.

Hemostasis radiotherapy for gastric cancer: Usefulness of the gastric cancer to spleen apparent diffusion coefficient ratio

“…The hemostatic effect of radiotherapy on gastric cancer has been confirmed previously by our group and Tey et al in prospective trials [ 1 , 2 ]. Our study reported the effectiveness of hemostatic irradiation and the possibility of re-irradiation [ 3 , 4 ], and Tey et al reported on quality of life.…”

“…Subsequently, 15 Gy/5 fractions treatment was administered to patients who had rebleeding and wished to be re-irradiated. Hemostasis was observed in 6/6 (100%) [1] . On the other hand, according to the report by Tey et al , the same therapeutic degree of effect was observed in 40/50 (80%) of their patients [2] .…”

“…We have previously reported the efficacy and safety of re-irradiation [ 1 , 3 , 4 ]. By lowering the initial irradiation dose, the OAR dose in the case of re-irradiation could be lowered.…”

“…The patient received salvage hemostatic irradiation and DWI immediately before, 1 month after, and 3 months after treatment during salvage irradiation. We have previously reported efficacy in hemostatic irradiation for gastric cancer [1] , but when irradiating the entire stomach, the spleen may fall within the irradiation range. However, it is known that the apparent diffusion coefficient (ADC) of the spleen shows an almost constant value (the ADC is low) regardless of whether it is inside or outside the irradiation range.…”

Adrenal Stereotactic Body Radiation Therapy: The Effects of a Full and Empty Stomach on Radiation Dose to Organs at Risk

“…This study reveals that the adrenal glands may be able to regulate the radiation dose to the stomach and left kidney by changing the shape (size) of the stomach. MRI-Linac can reduce the target's intra-and intervariance but not the contents of the stomach [17]. Therefore, we believe that MR-Linac will become widespread, but also that such a method of arti cially changing the shape and position of organs is necessary.…”