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

Abstract

To evaluate the response and quality of life of palliative gastric radiotherapy in patients with symptomatic locally advanced gastric cancer. Patients with bleeding, pain or obstruction and were treated with palliative gastric radiotherapy to a dose of 36 Gy in 12 daily fractions. The primary outcomes were symptom response rates. Secondary outcomes included overall survival, adverse events and proportion of patients with ≥10‐point absolute improvement in the fatigue, nausea/vomiting and pain subscales in the EORTC Qualify of Life Questionnaire C30 (EORTC QLQ‐C30) and dysphagia/pain subscales in the gastric specific module (STO22) at the end of RT and 1 month after the completion of radiotherapy. Fifty patients were accrued. Median survival duration was 85 days. 40/50 patients (80%) with bleeding, 2/2 (100%) patients with obstruction and 1/1 (100%) patient with pain responded to radiotherapy. Improvements fatigue, nausea/vomiting and pain subscales of the EORTC QLQ‐C30 was seen in 50%, 28% and 44% of patients at the end of RT and in 63%, 31% and 50% of patients 1 month after RT. Improvements in dysphagia/pain subscales of the STO22 was seen in 42% and 28% of patients at then end of RT and 44% and 19% of patients 1 month after RT. Two patients (5%) had grade 3 anorexia and gastritis. Palliative gastric radiotherapy was effective, well tolerated and resulted in improvement in fatigue, dysphagia and pain at the end of radiotherapy and 1 month after the completion of radiotherapy in a significant proportion of patients.

Palliative radiotherapy for gastric cancer: Is there a dose relationship between bleeding response and radiotherapy?

“…We identified eleven non-comparative retrospective studies, which included 409 patients treated with EBRT to control bleeding due to local recurrence/progression of GC (11,(17)(18)(19)(20)(21)(22)(23)(24)(25)(26). Figure 1(a).…”

“…describes the search strategy and the reasons for the exclusion of some studies. Ten of the studies were retrospective (11,(17)(18)(19)(20)(21)(22)(23)(24)(25), and one was prospective (26); all were published between 2008 and 2019. Gastroscopy was used to confirm gastric bleeding in all patients.…”

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

“…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.…”

Management of Bleeding from Unresectable Gastric Cancer

“…Palliative RT has been shown to be effective in patients with tumor bleeding from not only GC [27,28,29,30,31,32,33,34] but also malignancies of various origins [35,36,37,38]. However, only a few patients with initial hemostatic failure of ET or rebleeding after ET underwent hemostatic RT [4,9,11], and hemostatic RT is not common in most facilities in Japan [39].…”

“…We identified seven recent studies that reported the outcomes of palliative RT for GC bleeding [27,28,29,30,31,32,33] (Table 3 and Table 4) and a systemic review article [34] published. One study was a prospective phase II study [33], and six were retrospective [27,28,29,30,31,32]. Three of these studies included the assessment of not only bleeding but also pain and/or obstruction [28,32,33].…”