A Retrospective Study of Rapid Symptom Response in Bleeding Gynecologic Malignancies With Short Course Palliative Radiation Therapy: Less is More

Butala, Anish A.; Lee, Daniel Y.; Patel, Roshal R.; Latif, Nawar; Haggerty, Ashley; Paydar, Ima; Jones, Joshua; Taunk, Neil K.

doi:10.1016/j.jpainsymman.2020.08.011

Cited by 7 publications

(4 citation statements)

References 22 publications

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“…), making interpretation of the combined results challenging [ 4 ]. One of the few contemporary studies that focused specifically on patients with bleeding GYN malignancies following palliative RT reported similar overall findings to those reported here [ 8 ]. While they did not find a statistically significant difference in the time to bleeding cessation in their small cohort of incurable patients receiving palliative RT, time to bleeding cessation was numerically less with more hypofractionated RT and with similar times to bleeding cessation compared to those reported here.…”

Section: Discussionsupporting

confidence: 88%

Hypofractionated radiation leads to more rapid bleeding cessation in women with vaginal bleeding secondary to gynecologic malignancy

et al. 2022

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Background Vaginal bleeding (VB) is common in women with gynecologic (GYN) malignancies. Radiation therapy (RT) is used for the definitive treatment of GYN cancers and palliation of bleeding. The historical dogma is that high dose-per-fraction radiation leads to more rapid bleeding cessation, yet there is scant data supporting this claim. We sought to examine the effect of RT fraction size on VB via retrospective analysis of patients receiving hypofractionated radiation (HFRT) compared to conventionally fractionated radiation (CFRT) for control of bleeding secondary to GYN malignancies. Methods We identified patients receiving external beam RT for continuous VB from GYN malignancy treated in our department from 2012 to 2020. RT was classified as HFRT (> 2.0 Gy/fx) or CFRT (1.8–2.0 Gy/fx). Demographic information, disease characteristics, and treatment details were collected. The primary endpoint was days from RT initiation until bleeding resolution. Characteristics between groups were compared via Fisher’s exact test. Time to bleeding cessation was assessed via Kaplan–Meier and log-rank test. Univariable and multivariable Cox-proportional hazards were used to identify factors associated with bleeding cessation. Results We identified 43 patients meeting inclusion criteria with 26 and 17 patients receiving CFRT and HFRT, respectively. Comparison of baseline characteristics revealed patients receiving HFRT were older (p = 0.001), more likely to be post-menopausal (p = 0.002), and less likely to receive concurrent chemotherapy (p = 0.004). Time to bleeding cessation was significantly shorter for patients receiving HFRT (log-rank p < 0.001) with median time to bleeding cessation of 5 days (HFRT) versus 16 days (CFRT). Stratification by dose-per-fraction revealed a dose–response effect with more rapid bleeding cessation with increased dose-per-fraction. While HFRT, age, recurrent disease, prior pelvic RT, and prior systemic therapy were associated with time to bleeding cessation on univariable analysis, HFRT was the only factor significantly associated with time to bleeding cessation in the final multivariable model (HR 3.26, p = 0.008). Conclusions Patients with continuous VB from GYN tumors receiving HFRT experienced more rapid bleeding cessation than those receiving CFRT. For patients with severe VB, initiation of HFRT to control malignancy related bleeding quickly may be warranted.

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Section: Discussionsupporting

confidence: 88%

Hypofractionated radiation leads to more rapid bleeding cessation in women with vaginal bleeding secondary to gynecologic malignancy

et al. 2022

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“…There was no influence of applied RT dose on OS in both of the studies, whereas Cihoric et al [ 4 ] report a significantly better OS in patients’ receiving > 30 Gy compared to < 30 Gy. Butala et al [ 40 ] report in a recent retrospective data series of 33 patients suffering from bleeding complications by pelvic gynecological malignancies, indicating that short-course RT (herein defined as less than or equal to five fractions, > 3.5 Gy/fraction) is equally effective as conventionally fractionated three courses > 5 fractions. Keeping the short median OS of this patient’s cohort in mind, we acknowledge the need to evaluate on a highly individual level for the best of the patients’ needs.…”

Section: Discussionmentioning

confidence: 99%

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

Guhlich,

Maag,

Dröge

et al. 2023

Radiat Oncol

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Background Significant bleeding of tumor sites is a dreaded complication in oncological diseases and often results in clinical emergencies. Besides basic local and interventional procedures, an urgent radiotherapeutic approach can either achieve a bleeding reduction or a bleeding stop in a vast majority of patients. In spite of being used regularly in clinical practice, data reporting results to this therapy approach is still scarce. Methods We retrospectively analyzed 77 patients treated for significant tumor-related bleeding at our clinic between 2000 and 2021, evaluating treatment response rate, hemoglobin levels, hemoglobin transfusion necessity, administered radiotherapy dose and overall survival. Results Response rate in terms of bleeding stop was 88.3% (68/77) in all patients and 95.2% (60/63) in the subgroup, wherein radiotherapy (RT) was completed as intended. Hemoglobin transfusions decreased during treatment in a further subgroup analysis. Median overall survival (OS) was 3.3 months. Patients with primary tumors (PT) of the cervix (carcinoma of the cervix, CC) or endometrium (endometrioid carcinoma, EDC) and patients receiving the full intended RT dose showed statistically significant better OS in a multivariable cox regression model. Median administered dose was 39 Gy, treatment related acute toxicity was considerably low. Conclusions Our data show an excellent response rate with a low toxicity profile when administering urgent radiotherapy for tumor related clinically significant bleeding complications. Nonetheless, treatment decisions should be highly individual due to the low median overall survival of this patient group.

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“…In cases of malignant bleeding in patients with advanced disease, practices may shift toward short courses of radiation, similar to ASTRO guidelines recommending single or short course fractions for bone metastases [13]. Short course radiation therapy addresses symptomatic disease while minimizing patient burden and toxicity compared with conventional long-course regimens [14 ▪ ].…”

Section: Symptom Managementmentioning

confidence: 99%

Update in palliative care in gynecologic oncology

Karlin

Khoo

Pietras

2021

Current Opinion in Obstetrics &Amp; Gynecology

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Purpose of reviewThis review summarizes research advances in quality of life, symptom management, and end-of-life practices within palliative care that can benefit patients with gynecologic cancers. Recent findingsAddressing fertility issues, sexual side effects, and possible disease recurrence can promote quality of life in gynecologic cancer survivors. Cannabis can provide some benefit for nausea and neuropathic pain, yet for nonneuropathic pain presentations, it does not appear to provide significant benefit in reducing opioid usage. Lastly, palliative care outcomes, such as reduced aggressive care at the end of life and higher rates of hospice enrollment are augmented by the presence of an outpatient palliative care clinic.

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A Retrospective Study of Rapid Symptom Response in Bleeding Gynecologic Malignancies With Short Course Palliative Radiation Therapy: Less is More

Cited by 7 publications

References 22 publications

Hypofractionated radiation leads to more rapid bleeding cessation in women with vaginal bleeding secondary to gynecologic malignancy

Hypofractionated radiation leads to more rapid bleeding cessation in women with vaginal bleeding secondary to gynecologic malignancy

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

Update in palliative care in gynecologic oncology

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