Efficacy of Palliative Intent Hemostatic Radiation Therapy in Advanced Malignancies: A Tertiary Care Experience From Saudi Arabia

Abstract

The control of bleeding is of paramount importance in the management cancer patients. This study was undertaken to explore the outcomes after hemostatic radiation therapy (HRT) in advanced stage malignancies presenting with bleeding. Materials/Methods: Patients treated by HRT between 2014 and 2015 were analyzed retrospectively after obtaining approval from the Institutional Review Board. The degree of bleeding was assessed per the World Health Organization (WHO) scale (grade 0 Z no bleeding, 1 Z petechial bleeding, 2 Z clinically significant bleeding, 3 Z bleeding requiring transfusion, 4 Z bleeding associated with fatality). Our primary endpoint was bleeding at the end of radiation therapy, while the secondary endpoint was acute toxicity. Comparison was made for the bleeding scale before and after HRT using the Wilcoxon signed rank test. Results: A total of 28 patients with advanced malignancies that presented with bleeding were analyzed. Median age was 59 years (range, 30 e 92 years). Before treatment with HRT, bleeding was recorded as grade 2 in 15 (53%) and grade 3 in 13 (47%) patients. A median dose of 20 Gy (range, 8e40 Gy) of HRT was used to stop the bleeding. At the end of HRT, the results were promising with a statistically significant difference in bleeding (p < 0.001). Post HRT bleeding score was recorded as grade 0 in 68% (n Z 19), grade 1 in 21% (n Z 6), grade 2 in 7% (n Z 2), grade 3 in 4% (n Z 1) and grade 4 in none (n Z 0). An improvement was also noted in the median hemoglobin, which improved from 9.05 g/dL pre-HRT to 10.0 g/dL post-HRT. The median follow-up in our study was 1 month (range, 1 e 5 months), since most of the patients were discharged after palliative radiation therapy. Toxicity profile was reasonable with no grade 3 or above acute toxicity being observed in the study. Conclusion: HRT appears to be a safe and effective treatment modality for securing hemostasis in clinically bleeding patients.