94 Audit on outcome of patients with brain metastases treated with palliative whole brain radiotherapy (WBRT) over a period of 12 months, a single institution's experience

Chaw, C.L.; Lord, H.

doi:10.1016/s0169-5002(11)70094-0

Cited by 3 publications

(6 citation statements)

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“…However, there was no statistically significant difference in the OS between the hemostasis-alone group and the group of patients in whom hemostasis was not achieved, possibly because most of the patients had a limited life expectancy even at the time of initiation of the PRT. According to previous studies conducted in patients with gastric cancer, the rebleeding rate in patients in whom hemostasis is initially achieved with PRT is in the range of 25–50% [ 16 – 18 , 20 , 22 ]. In our cohort, rebleeding occurred in three out of the 14 patients (21.4%) in whom hemostasis was initially achieved, which was consistent with previous reports.…”

Section: Discussionmentioning

confidence: 99%

Palliative radiotherapy for tumor bleeding in patients with unresectable pancreatic cancer: a single-center retrospective study

Shibuki,

Sasaki,

Yamaguchi

et al. 2023

Radiat Oncol

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Background Patients with unresectable pancreatic cancer (PC) sometimes experience gastrointestinal bleeding (GIB) due to tumor invasion of the gastrointestinal tract (tumor bleeding); no standard treatment has been established yet for this complication. Palliative radiotherapy (PRT) could be promising, however, there are few reports of PRT for tumor bleeding in patients with unresectable PC. Therefore, we evaluated the outcomes of PRT for tumor bleeding in patients with unresectable PC. Methods We reviewed the medical records of patients with unresectable PC diagnosed at our institution between May 2013 and January 2022, and identified patients with endoscopically confirmed tumor bleeding who had received PRT. PRT was administered at a total dose of 30 Grays (Gy) in 10 fractions, 20 Gy in 5 fractions, or 8 Gy in a single fraction, and the dose selection was left to the discretion of the attending radiation oncologists. Results During the study period, 2562 patients were diagnosed as having unresectable PC at our hospital, of which 225 (8.8%) developed GIB. Among the 225 patients, 63 (2.5%) were diagnosed as having tumor bleeding and 20 (0.8%) received PRT. Hemostasis was achieved in 14 of the 20 patients (70%) who received PRT, and none of these patients developed grade 3 or more adverse events related to the PRT. The median time to hemostasis was 8.5 days (range 7–14 days). The rebleeding rate was 21.4% (3/14). The median hemoglobin level increased significantly (p < 0.001) from 5.9 to 9.1 g/dL, and the median volume of red blood cell transfusion tended (p = 0.052) to decrease, from 1120 mL (range 280–3360 mL) to 280 mL (range 0–5560 mL) following the PRT. The median overall survival (OS) was 52 days (95% confidence interval [CI] 39–317). Of the 14 patients in whom hemostasis was achieved following PRT, chemotherapy could be started/resumed in seven patients (50%), and the median OS in these patients was 260 days (95% CI 76–not evaluable [NE]). Three patients experienced rebleeding (21.4%), on days 16, 22, and 25, after the start of PRT. Conclusion This study showed that PRT is an effective and safe treatment modality for tumor bleeding in patients with unresectable PC.

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Section: Discussionmentioning

confidence: 99%

Palliative radiotherapy for tumor bleeding in patients with unresectable pancreatic cancer: a single-center retrospective study

Shibuki,

Sasaki,

Yamaguchi

et al. 2023

Radiat Oncol

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“…Many reports have established the criteria for the hemostatic effect of RT when BT is not required for more than four weeks. 5–9 , 14 In most of the previous studies, the hemostatic effect of RT ranged from 50% to 80%, with a median duration of response in the range of 1.5–11.4 months. 5–9 , 11 , 14 Tey et al reported an overall pooled response rate for bleeding of 74% in their review article.…”

Section: Discussionmentioning

confidence: 99%

“… 5–9 , 14 In most of the previous studies, the hemostatic effect of RT ranged from 50% to 80%, with a median duration of response in the range of 1.5–11.4 months. 5–9 , 11 , 14 Tey et al reported an overall pooled response rate for bleeding of 74% in their review article. 12 In our case series, we observed that the hemostatic effect of RT lasted for more than one month in the 25 patients who survived; three patients died within a month (without BT).…”

Section: Discussionmentioning

confidence: 99%

“… 6 Recent studies have demonstrated that short course RT with less than BED 10 of 39 Gy (BED 10 = 28 Gy; 20 Gy in 5 fractions, BED 10 = 14.4 Gy; a single 8 Gy fraction), which is a more suitable option for patients with limited life expectancy, has a similar hemostatic effect as longer course RT with more than BED 10 of 39 Gy, which has a risk of increased interruptions of RT and/or prolongation of hospital stay. 14 , 19 , 20 …”

Section: Discussionmentioning

confidence: 99%

“…Although the role of dose escalation for improved tumor control remains to be established, the homeostatic effect should be evaluated within prospective studies of RT with hypofractionation, which has a shorter overall treatment time. 10 , 14 , 23 …”

Section: Discussionmentioning

confidence: 99%

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Hemostatic Effect of Palliative Radiation Therapy in Preventing Blood Transfusions from Bleeding Occurring within Advanced Gastric Cancer

Mitsuhashi

Ikeda

Nemoto

et al. 2021

Palliative Medicine Reports

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Purpose: To report the hemostatic effects of palliative radiation therapy (RT) for the prevention of blood transfusions (BT) in patients with advanced gastric cancer (AGC). Methods and Materials: Twenty-eight patients who received palliative three-dimensional conformal RT for hemostasis of gastric bleeding were retrospectively assessed in a study conducted in Japan. The median follow-up was 143.5 days. Changes in hemoglobin (Hb) levels were compared at the beginning of RT and four weeks later. Blood transfusion-free survival (BTFS) and overall survival (OS) were measured from the beginning of RT. Treatment toxicity was evaluated within 60 days of RT initiation. Results: No statistically significant decrease in Hb level was observed four weeks after RT. Twenty-eight patients did not receive BT within a month after RT, of whom three died within a month; 6/28 patients (21%) received BT at a median interval of 99.5 days following RT. The one-year BTFS and OS rates for all patients were 69% and 12%, respectively. The one-year BTFS was statistically significantly higher in 17 patients treated with a biologically effective dose (BED) 10 of 39 Gy (30 Gy in 10 fractions) (78%) compared with six patients treated with a BED 10 of 48 Gy (40 Gy in 20 fractions) (25%). Grade 1 and 2 nausea ( n = 11) and a Grade 2 increase in alanine aminotransferase ( n = 1) were observed. One patient died of Grade 5 hemorrhage. Conclusions: Palliative RT is an effective treatment to prevent BT for bleeding occurring within AGC. Specifically, a fractionation regimen of 30 Gy in 10 fractions (a BED 10 of 39 Gy) has a more durable hemostatic effect and thus should be considered for better prognosis.

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Clinical outcomes of palliative 3-dimensional conformal external beam gastric radiotherapy: single center experience

ÖZTÜRK,

ALTINIŞIK İNAN,

ARAL

et al. 2023

J Med Palliat Care / JOMPAC / jompac

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Aim: Patients diagnosed with locally advanced and/or metastatic gastric cancer and who cannot undergo surgery may need palliative treatment during their follow-up. There is scarce data about outcomes of palliative gastric radiotherapy (RT). In this study, we aimed to investigate the effect of 3-D external beam RT on oncological outcomes, as a non-invasive method.Material and Method: From 2013 to 2017, sixteen gastric cancer patients treated with palliative external RT in our institutional clinic were evaluated. Only patients who received palliative gastric radiotherapy for obstruction, pain and bleeding were analyzed, and patients who had previously received RT to the abdomen or who were given RT for adjuvant purposes were not included in the analysis. Results: Seven patients (43%) were not able to finish the planned palliative course. Thirty Gray with 10 fractions was the most planned RT schedule. Almost half of the patients (%56) received chemotherapy before RT. Overall survival was found to be median 2 months. Median survival was better in patients who were able to receive 28 Gy bioequivalent dose (4 vs 0.3 months, p≤0.00). Purpose of palliation also found to be a significant factor on survival. Patients who were referred for pain have found to be better survival rather than bleeding and obstruction (13 vs 0.7 months, p=0.03).Conclusion: External radiotherapy is an easily applicable and effective method for palliation in gastric cancer patients. Early referral for radiotherapy in patients who need palliation may increase oncological outcomes. It has been observed that the prognosis is worse in patients who received palliative radiotherapy due to gastric bleeding and obstruction.

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94 Audit on outcome of patients with brain metastases treated with palliative whole brain radiotherapy (WBRT) over a period of 12 months, a single institution's experience

Cited by 3 publications

References 0 publications

Palliative radiotherapy for tumor bleeding in patients with unresectable pancreatic cancer: a single-center retrospective study

Palliative radiotherapy for tumor bleeding in patients with unresectable pancreatic cancer: a single-center retrospective study

Hemostatic Effect of Palliative Radiation Therapy in Preventing Blood Transfusions from Bleeding Occurring within Advanced Gastric Cancer

Clinical outcomes of palliative 3-dimensional conformal external beam gastric radiotherapy: single center experience

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