Palliative external beam radiotherapy for the treatment of tumor bleeding in inoperable advanced gastric cancer

Abstract

BackgroundTo assess the outcomes and prognostic factors associated with palliative external beam radiotherapy (EBRT), administered to patients with advanced gastric cancer.MethodsForty-two patients with bleeding gastric tumors that received EBRT for palliation were analyzed. The response to EBRT was assessed by the palliation of tumor bleeding. Patients were classified as either responders, or non-responders to EBRT. The prognostic utility of clinical and dosimetric variables was examined in a multivariate logistic regression model. The optimal dose cutoff to classify the two groups was determined with receiver operating characteristic analysis.ResultsThe palliation of gastric tumor bleeding after EBRT was achieved in 29 patients (69.0%). The time to resolve tumor bleeding ranged from 1 to 84 days (median, 15 days). The median duration of palliation was 14.9 weeks. The median EBRT dose was 40 Gy in responders vs. 21 Gy in non-responders, with the difference being significant (p < 0.001). The biologically effective dose (using α/β = 10, BED10) for responders was significantly higher than the BED10 for non-responders (median 48 Gy vs. 26.4 Gy, p < 0.001), and the optimal cut off value to separate the two groups was 36 Gy (p < 0.001). The absence of distant metastasis and the use of concurrent chemotherapy generally showed a better EBRT response (p = 0.079 and p = 0.079, respectively). In the multivariate analysis, BED10 ≥ 36 Gy was the most significant factor associated with EBRT response (p = 0.001). Overall survival (OS) and re-bleeding-free survival was median 12.6 weeks and 14.9 weeks. The responders to EBRT showed superior OS (16.6 vs. 5.1 months, p < 0.001). Neither acute nor chronic toxicities of grade 3 or higher were observed.ConclusionsEBRT is an effective method for treating tumor bleeding in advanced gastric cancer, and does not induce severe toxicity.

Short-course palliative radiation therapy leads to excellent bleeding control: A single centre retrospective study

“…The present study shows that the use of hemostatic radiotherapy is effective and provides excellent primary bleeding control, with an overall rate of 89%, varying from 80% to 100% depending on the site of bleeding. The rates by site are comparable with the bleeding control rates reported in other isolated series of palliative external beam radiotherapy (EBRT) for gastro-intestinal [9] , [10] , [11] , urinary tract [12] , respiratory tract [13] , and gynecological origin [14] . At the time of publication, our study is the first report on hemostatic RT which includes extremity and H&N sites.…”

“…Likewise, Tey et al [10] conducted a similar analysis and reported 80% bleeding control in 103 cases, defined as the interruption in blood transfusions or gastroscopy for hemostasis, but similarly no increase in response ratio with higher BED (>39 Gy 10 ) ( p = 0.78). Alternatively, Lee et al [11] performed a small analysis of 42 patients treated with palliative EBRT for tumor bleeding in inoperable advanced gastric cancer, reporting resolution of the bleeding in 69% of the cases, with a positive association between BED ≥ 36 Gy 10 and bleeding resolution ( p < 0.001).…”

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

“…There is substantial evidence that palliative radiotherapy (RT) is effective in the management of bleeding, with reported treatment response (i.e. that bleeding would stop or diminish) varying from 45% to 100% [2] , [3] , [4] , [5] , [6] , [7] , [8] , [9] , [10] , [11] , [12] , [13] , [14] , [15] , [16] , [17] , [18] , [19] , [20] , [21] , [22] , [23] , [24] , [25] . It is, however, not clear which RT schedule, with regard to fractionation and total dose, is most ‘optimal’ (with as less fractions and less toxicity for the patient and as much as possible effect on symptom control) to manage bleeding.…”

“…pain or obstruction) and the aim to reduce tumour volume can influence the chosen fractionation and total dose. Therefore, RT schedules described in literature vary considerably between studies (total dose ranged from 5 to 76 Gray {Gy}, number of fractions ranged from 1 to 39), consisting of only a few randomized controlled trials (RCTs) that compared different RT schedules, mainly with limited numbers of patients [2] , [3] , [4] , [5] , [6] , [7] , [8] , [9] , [10] , [11] , [12] , [13] , [16] , [17] , [18] , [20] , [22] , [23] . Table 1 summarizes the main studies on palliative radiotherapy in the management of bleeding using external beam radiotherapy (randomized and retrospective studies including information with regard to bleeding of at least 30 patients) that provide information with regard to fractionation schemes used, the bleeding control rate and/or duration of bleeding control.…”

“…Table 1 summarizes the main studies on palliative radiotherapy in the management of bleeding using external beam radiotherapy (randomized and retrospective studies including information with regard to bleeding of at least 30 patients) that provide information with regard to fractionation schemes used, the bleeding control rate and/or duration of bleeding control. In general, reviews for hematemesis, rectal bleeding and vaginal bleeding show response rates between 50% and 90% [6] , [7] , [8] , [16] . For haemoptysis and haematuria limited RCT data are available, showing no difference in treatment response rates: for haemoptysis response rates vary between 54% and 86% for different RT schedules (range 10–60 Gy in 1–39 fractions) [2] , [3] , [22] .…”