Palliative radiotherapy for gastric cancer: a systematic review and meta-analysis

Abstract

Background/PurposeTo review the efficacy and toxicity of palliative radiotherapy (RT) for symptomatic locally advanced gastric cancer (GC) and to determine the optimal RT schedule for symptom palliation.MethodsWe searched MEDLINE and CENTRAL for eligible studies published from 1995 to 2015. Outcomes of interest were relief of bleeding, pain and obstruction.RESULTSSeven non-comparative observational studies were included. There were large variations in RT dose and fractionation. The pooled overall response rates for bleeding, pain and obstruction symptoms were 74%, 67% and 68% respectively. There was no difference in response rate of bleeding between regimens with high biological equivalent dose (BED) of = 39Gy versus regimens with low BED<39Gy regimens (p value =0.39). Grade 3 to 4 toxicities occurred in up to 15% of patients for patients treated with RT alone and up to 25% of patients treated with chemoradiotherapy. Health-related quality of life (HRQL) outcomes were not reported.ConclusionMore than two-thirds of patients receiving RT would have a clinical benefit. Low BED regimens appear to be adequate for symptom palliation. Toxicity rates appear acceptable for patients treated with RT alone. The optimal dose fractionation regimen for symptom palliation remains unclear. Prospective studies to determine the effects of palliative gastric RT on HRQL outcomes are warranted.

Efficacy of Palliative Bladder Radiotherapy for Hematuria in Advanced Bladder Cancer Using Contemporary Radiotherapy Techniques

“…Our results are consistent with outcomes of palliative radiotherapy for other tumour sites (2,3,5). In a systematic review of palliative RT for hemoptysis in lung cancer, Fairchild et al have reported that there was no significant difference in response rates between high dose versus low dose regimens (2).…”

“…Effective treatments with low toxicity are preferred for patients with advanced disease and limited life expectancy. Palliative RT has been shown to be effective in treating bleeding at other cancer sites, including lung and gastric cancers (2)(3)(4)(5). It has the benefit of controlling the symptoms while reducing the burden of symptoms.…”

Palliative radiotherapy in symptomatic locally advanced gastric cancer: A phase II trial

“…However, there is limited research on palliation of symptoms resulting from primary gastric tumor. A systematic review and meta‐analysis of published studies on the efficacy of palliative gastric RT found that there were no prospective studies examining this issue . The interpretation of the retrospective studies on the efficacy of palliative gastric RT is limited by the use of concurrent chemotherapy, different definitions of endpoints and the use of different radiation dose fractionation schedules.…”

Current trends in gastric cancer treatment in Europe

“…Guidelines mention that hypo-fractionated radiotherapy is an effective and well-tolerated treatment option for symptomatic locally advanced or recurrent disease [71] . In non-comparative observational studies, the overall response rates for bleeding, pain and obstruction symptoms were 74%, 67% and 68% respectively, low biological equivalent dose of > 39 Gy regimens appear to be adequate for symptom palliation [72] .…”