Palliative radiotherapy for bleeding from advanced gastric cancer: is a schedule of 30 Gy in 10 fractions adequate?

Asakura, Hirofumi; Hashimoto, Takayuki; Harada, Hideyuki; Mizumoto, Masashi; Furutani, Kazuhisa; Hasuike, Noriaki; Matsuoka, Masaki; Ono, Hiroyuki; Boku, Narikazu; Nishimura, Tetsuo

doi:10.1007/s00432-010-0866-z

Cited by 88 publications

(73 citation statements)

References 10 publications

(14 reference statements)

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“…External beam radiation therapy plays a well-defined role in the control of bleeding in patients with localized but unresectable tumors [50][51][52][53][54][55]. Palliative doses ranging from 8 Gy per single fraction to 40 Gy in 16 fractions can control the bleeding in approximately 80% of all patients [55].…”

Section: Radiotherapymentioning

confidence: 99%

Upper Gastrointestinal Bleeding in Oncological Patients

Alberti

Santos

Àlex

et al. 2016

GHOA

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Bleeding is a relatively common phenomenon in patients with solid neoplasms, occurring in up to 10% of all patients in advanced stages of cancer. Therefore, this study aims to discuss clinical support management, endoscopic strategies, radiotherapy, chemotherapy, as well as endovascular and surgical interventions. AbstractBleeding is a relatively common phenomenon in patients with solid neoplasms, occurring in up to 10% of all patients in advanced stages of cancer. The objective of this article is to review the etiology, clinical manifestations, and treatment of acute upper gastrointestinal bleeding in cancer patients, understanding that chronic and occult blood losses are not within the scope of this text. To achieve better outcomes in the management of this entity, a multidisciplinary approach is mandatory. Therefore, this study aims to discuss clinical support management, endoscopic strategies, radiotherapy, chemotherapy, as well as endovascular and surgical interventions.

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Section: Radiotherapymentioning

confidence: 99%

Upper Gastrointestinal Bleeding in Oncological Patients

Alberti

Santos

Àlex

et al. 2016

GHOA

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“…Active bleeding is one of the most serious and fatal complications in patients with advanced gastric cancer [1][2][3][4][5]. The incidence of gastric cancer with bleeding is reported to be about 1-8 % [6][7][8].…”

Section: Introductionmentioning

confidence: 99%

The successful endoscopic hemostasis factors in bleeding from advanced gastric cancer

et al. 2012

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Background When patients with advanced gastric cancer experience active bleeding, gastroenterologists normally choose between two treatment modalities, endoscopic hemostasis and transarterial embolization (TAE). In patients with advanced gastric cancer with bleeding, the predictive factors for endoscopic hemostatic failure are still unknown. Thus, the purpose of this study was to evaluate predictive factors for endoscopic hemostasis failure and to differentiate which hemostasis procedure is more effective for advanced gastric cancer with bleeding. Methods We reviewed the medical records of patients who were diagnosed with advanced gastric cancer and acute non-variceal gastric bleeding from January 2006 to August 2011. Forty-five patients were enrolled in this study and they were divided into a group of 14 patients who had experienced successful endoscopic hemostasis and a group of 31 patients who had had unsuccessful hemostasis with the first endoscopy and then underwent TAE. Results Lesion size and bleeding condition of Forrest class 1a or 1b were statistically significant predictive factors for endoscopic hemostatic failure (P = 0.023 and P = 0.017, respectively). On multivariate logistic regression analysis, size (lesion [2 cm) was a significant predictive factor for endoscopic hemostatic failure [adjusted odds ratio (aOR) 8.056; 95 % confidence interval (CI) 1.329-48.846].Conclusions We determined that small bleeding lesions (\2 cm) and exposed vessels in the bleeding site with gastric cancer indicated that endoscopic hemostasis would be an effective hemostatic modality to choose. Particularly, in the opposite condition, the presence of large bleeding lesions ([2 cm) and non-exposed vessel bleeding with a tumor, endoscopic hemostasis failure is predicted and TAE could be recommended.

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“…A retrospective series of 30 Japanese patients with gastric cancer and persistent upper gastrointestinal bleeding reported that 22 patients (73%) responded to radiotherapy, 11 of whom (50%) experienced rebleeding (median time to rebleeding 3.3 months). 50 Patients who received chemoradiotherapy (n = 12) had a significantly lower rebleeding rate than those undergoing radiotherapy alone (36.4% versus 63.6%; P <0.001). 50 The use of radiotherapy has also been limited to symptom control in patients with node-positive gastric cancer recurrence after curative gastrectomy-because such recurrence is considered incurable-and the role of radiotherapy in this setting is not well defined.…”

Section: Palliative Radiotherapymentioning

confidence: 89%

“…50 Patients who received chemoradiotherapy (n = 12) had a significantly lower rebleeding rate than those undergoing radiotherapy alone (36.4% versus 63.6%; P <0.001). 50 The use of radiotherapy has also been limited to symptom control in patients with node-positive gastric cancer recurrence after curative gastrectomy-because such recurrence is considered incurable-and the role of radiotherapy in this setting is not well defined. However, a small retrospective study has supported a benefit of aggressive local palliative radiotherapy in prolonging the survival of patients with isolated nodal metastases.…”

Section: Palliative Radiotherapymentioning

confidence: 89%

Does surgery have a role in managing incurable gastric cancer?

et al. 2015

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Although the incidence of gastric cancer is decreasing, the outcomes of this disease are among the poorest of all solid-organ tumours, predominantly due to the frequent presence of stage IV metastatic disease at primary presentation. Stage IV gastric cancer is incurable and carries a very poor prognosis (5-year survival rate of ∼4%); palliative chemotherapy remains the standard of care, but increasing evidence indicates that palliative surgery can provide a prognostic and symptomatic benefit, particularly in combination with chemotherapy and/or radiotherapy. Ongoing prospective trials should further clarify the efficacy of palliative surgery in comparison with other treatment modalities. Until such data are available, surgery should not be offered as a standard first-line treatment, but can be considered in selected cases after thorough multidisciplinary discussions involving the patient. Patient selection for both gastrectomy and nonresectional surgery must include consideration of various factors that predict quality of life after surgery. This Perspectives summarizes the available evidence and discusses the utility of palliative surgery in relation to other therapeutic modalities in the management of incurable gastric cancer.

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Palliative radiotherapy for bleeding from advanced gastric cancer: is a schedule of 30 Gy in 10 fractions adequate?

Abstract: RT with 30 Gy in 10 fractions is an adequate treatment for bleeding from advanced gastric cancer, especially in patients with poor prognosis.

Cited by 88 publications

References 10 publications

Upper Gastrointestinal Bleeding in Oncological Patients

Upper Gastrointestinal Bleeding in Oncological Patients

The successful endoscopic hemostasis factors in bleeding from advanced gastric cancer

Does surgery have a role in managing incurable gastric cancer?

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