Patterns of practice in palliative radiotherapy for bleeding tumours in the Netherlands; a survey study among radiation oncologists

Strijbos, Jennifer; Linden, Yvette M. van der; Vos-Westerman, Hanneke; Baardwijk, Angela van

doi:10.1016/j.ctro.2019.01.004

Cited by 9 publications

(7 citation statements)

References 33 publications

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“…However, short-course hypofractionated schemes such as 1 × 8 Gy were shown to achieve equal bleeding control of approximately 90%, with lower risks of treatment interruption, incompliance, and hospitalization [ 30 ]. A single fraction of 8 Gy also emerged as the preferred scheme for hemoptysis in a large survey among Dutch radiation oncologists [ 31 ]. The reported fractionation schemes used for patients with hemoptysis caused by CPA may have been guided by the established and conservative hemostatic schemes.…”

Section: Discussionmentioning

confidence: 99%

Stereotactic body radiotherapy for recurrent hemoptysis due to chronic pulmonary aspergillosis: a case report and systematic review of the literature

et al. 2022

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Purpose Chronic pulmonary aspergillosis (CPA) can manifest as fungus balls in preexisting cavities of lung parenchyma and recurrent hemoptysis is among the most frequent complications. Radiotherapy can be considered for treatment-refractory aspergilloma and severe hemoptysis. To the best of our knowledge, we present the first application of stereotactic body radiotherapy (SBRT) for a pulmonary aspergilloma in a patient with limited functional lung capacity. The topic was further expanded on with a systematic review of the literature addressing the implementation of radiotherapy in CPA patients. Case report A 52-year-old man presented with recurring and treatment-refractory hemoptysis caused by chronic cavitary aspergillosis localized in the left lower lobe. We applied SBRT on two consecutive days with a total dose of 16 Gy. Hemoptysis frequency decreased to a clinically insignificant level. Systematic review We performed a systematic search of the literature in line with the PRISMA statement. The initial PubMed search resulted in 230 articles, of which 9 were included. Results The available literature contained 35 patients with CPA who received radiotherapy. Dose fractionation usually ranged from 2 to 4 Gy per fraction, applied almost exclusively in conventional two-dimensional (2D) techniques. There is no report of SBRT usage in such a scenario. Most cases report a positive treatment response after irradiation. Conclusion The presented case demonstrates long-term clinical stability after SBRT for recurrent hemoptysis due to pulmonary aspergilloma. The systematic literature search revealed that concept definition is still uncertain, and further work is necessary to establish radiotherapy in clinical practice.

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Section: Discussionmentioning

confidence: 99%

Stereotactic body radiotherapy for recurrent hemoptysis due to chronic pulmonary aspergillosis: a case report and systematic review of the literature

et al. 2022

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“…While the exact mechanism by which radiation can control acute bleeding from a malignancy is not yet well understood, it is thought that vascular endothelial damage by cellular apoptosis may induce vascular thrombosis. Radiation as a primary hemostatic treatment for bleeding malignancies has been well reported in human literature, with successful control of haemorrhage ranging from 45% to 100% of cases reported, across various tumour types and locations 25 …”

Section: Discussionmentioning

confidence: 99%

“…Acute hemoabdomen due to adrenal haemorrhage is considered a surgical emergency and is associated with a 50% risk of perioperative mortality. 23 For all 3 pets that were presented with acute 25 This study is inherently limited by its retrospective nature. Follow up times were varied, and not all clients returned with their pets for post-treatment imaging, preventing an accurate assessment of the post-treatment tumour and thrombus size across the entire cohort, as well as determination of a progression-free interval, or durability of radiation therapy.…”

Section: Outcomementioning

confidence: 99%

Stereotactic body radiation therapy as an alternative to adrenalectomy for the treatment of pheochromocytomas in 8 dogs

Linder

Wakamatsu

Jacovino

et al. 2022

Vet Comparative Oncology

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The objective of this report is to describe the use and outcome of stereotactic body radiation therapy (SBRT) for treatment of pheochromocytomas in 8 dogs. Pheochromocytomas are an uncommon but challenging tumour to manage. Adrenalectomy is the standard of care for treatment of pheochromocytomas in both animals and humans; however, unpredictable catecholamine secretion from the tumour and vascular and local invasion of the tumour and thrombi can pose life‐threatening perioperative and anaesthetic risks. SBRT has been investigated as an alternative to adrenalectomy in human patients with pheochromocytomas. Eight dogs with clinical signs, an adrenal mass, and cytology and/or urine normetanephrine/creatinine ratios consistent with pheochromocytoma were treated with SBRT in lieu of adrenalectomy. Three dogs presented with acute hemoabdomen. Seven dogs had caval tumour invasion, 3 with extension into the right atrium. Following SBRT, all dogs had complete resolution of clinical signs and reduced urine normetanephrine/creatinine ratio and/or tumour size. No significant anaesthetic complications were encountered. Acute radiation toxicity was limited to grade I gastrointestinal signs in 3 dogs and resolved within 1–2 days of symptomatic therapy. Five of 8 dogs were alive at the time of follow up, with a median follow up time of 25.8 months. SBRT resulted in a favourable outcome and mitigated the life‐threatening risks of adrenalectomy in these 8 dogs. SBRT may be a safe and effective alternative to adrenalectomy for pheochromocytomas in dogs with non‐resectable tumours, or for owners averse to the risks of surgery.

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“…In a survey conducted in the Netherlands, nine distinct palliative RT schedules for bleeding tumors were identified, including 1 • 8 Gy, 2 • 8 Gy, 5 • 4 Gy, 5 • 5 Gy, and 10-13 • 3 Gy. 25 In Japan, the fractionation schedules for palliative RT used to achieve resolution of MH varied widely according to the primary tumor sites, such as gastrointestinal and genitourinary tumors, and/or the patients' general condition. The most frequently used fractioned schema was 30 Gy administered in 10 fractions.…”

Section: Discussionmentioning

confidence: 99%

Palliative Radiation Therapy for Macroscopic Hematuria Caused by Urothelial Cancer

Zhang

Hojo

Raturi

et al. 2020

Palliative Medicine Reports

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Background: To assess the efficacy and toxicity profiles of palliative radiation therapy (RT) for macroscopic hematuria (MH) caused by urothelial cancer. Methods: A total of 25 urothelial cancer patients with MH who underwent palliative RT between 2008 and 2018 were analyzed in this retrospective study. The hematuria-free survival (HFS) time was defined as the period from complete resolution of MH to the recurrence of MH, death, or the last follow-up examination. Adverse events were classified according to the Common Terminology Criteria for Adverse Events version 4.0. Results: By the end of the median follow-up duration of 90 days (11-886 days), complete resolution of MH had been achieved in 22 patients (88%), and the median interval between the start of RT and resolution of MH was 9 days (2-179 days). Of the 22 patients in whom the symptom resolved, 9 (41%) developed recurrent MH, and the median time to relapse of MH was 129 days (30-692 days). The median RT dose was 30 Gy (20-40 Gy). Nine (36%) patients received a blood transfusion before the RT. The three-month HFS rate was 52.1%. There was a significant difference in the three-month HFS rate between patients with and without a history of pretreatment blood transfusion (HFS rate: 34.6% vs. 61.5%, p = 0.03). Grade 2 urinary tract pain and grade 3 diarrhea were seen in one patient each. Conclusion: Palliative RT appeared to be effective with limited toxicities for urothelial cancer patients with MH.

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Patterns of practice in palliative radiotherapy for bleeding tumours in the Netherlands; a survey study among radiation oncologists

Abstract: HighlightsCurrent practice in the Netherlands for radiotherapy of bleeding tumours varied considerably.Most often a single fraction of radiotherapy is chosen to treat a bleeding tumour.The choice of radiotherapy schedule is mainly influenced by patient related factors.

Cited by 9 publications

References 33 publications

Stereotactic body radiotherapy for recurrent hemoptysis due to chronic pulmonary aspergillosis: a case report and systematic review of the literature

Stereotactic body radiotherapy for recurrent hemoptysis due to chronic pulmonary aspergillosis: a case report and systematic review of the literature

Stereotactic body radiation therapy as an alternative to adrenalectomy for the treatment of pheochromocytomas in 8 dogs

Palliative Radiation Therapy for Macroscopic Hematuria Caused by Urothelial Cancer

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