The Efficacy of Hemostatic Radiotherapy for Advanced Malignancies Assessed by World Health Organization Bleeding Status

Abstract

This retrospective study aimed to evaluate the efficacy of radiotherapy for the palliation of bleeding symptoms of advanced malignancies. Patients and methodsWe included 36 consecutive patients treated for hemostatic intent by radiotherapy at our institution, from August 2013 to January 2019. Patient bleeding status was assessed according to the World Health Organization (WHO) bleeding status before and after radiotherapy. ResultsWe identified 36 consecutive patients, consisting of 14 men and 22 women. The median follow-up period after radiotherapy for all cases was 2.5 months (range: 0.4-37.7 months), and the one-year OS was 47.1% (95% confidence interval: 23.5%-67.6%). Of the 36 patients, 29 (81%) showed improvement by one point or more in the WHO bleeding status. A total of 15 patients received 30 Gy in 10 fractions with a biologically effective dose (BED10) of 39 Gy (high BED arm). The remaining 21 patients had received radiotherapy with a BED10 of less than 39 (low BED arm, range of BED10: 11.2-30 Gy). In the high BED arm, 14 of the 15 patients (91%) showed improvement on the WHO bleeding status. In the low BED arm, 15 of the 21 patients (71%) showed improvement on the WHO bleeding status. There was no statistically significant difference in the improvement rate between the high and low BED arms (p = 0.200). ConclusionThere is no universal standard to evaluate the hemostatic effect of palliative radiotherapy. In this retrospective study, we investigated the clinical outcomes of hemostatic irradiation as assessed by WHO bleeding status.

Hemostatic radiotherapy in clinically significant tumor-related bleeding: excellent palliative results in a retrospective analysis of 77 patients

“…Concerning the administered dose and fractionating schedule, Katano et al [ 10 ] report of higher bleeding remission in a group of patients with different primary tumors receiving biologically efficient dose (BED) 10 -equivalent of 39 Gy compared to patients < 39 Gy BED 10 (91% vs. 71%, not reaching statistical significance, likely due to few patient numbers [n = 36]). Ogita et al [ 39 ] demonstrated a statistically significant effect of BED 10 ≥ 36 Gy in patients receiving palliative RT for gross hematuria.…”

“…Often, red blood cells have to be supplemented [ 9 ]. Radiation therapy (RT) has been shown to achieve bleeding reduction or bleeding stop in a vast majority of administered patients [ 4 , 10 – 12 ]. An enhanced platelet adhesion to the extracellular matrix by an increase of von Willebrand factor was demonstrated in human cells ex vivo to be a possible short-term mode of action [ 13 ].…”