Verification of the Utility of Palliative Radiotherapy for Hemostasis of Gastric Cancer Bleeding: a Case Control Study

Sugita, Hirofumi; Sakuramoto, Shinichi; Mihara, Yoshiaki; Matsui, Kazuaki; Nishibeppu, Keiji; Ebara, Gen; Fuijta, Shohei; Fujihata, Shiro; Oya, Shuichiro; Miyawaki, Yutaka; Satô, Hiroshi; Horita, Yuki; Hamaguchi, Tetsuya; Noda, Shin‐ei; Kato, Shingo; Hirano, Yasumitsu; Okamoto, Koichi; Koyama, Isamu

doi:10.1007/s12029-021-00632-y

Cited by 6 publications

(8 citation statements)

References 16 publications

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“…Treating such time-dependent covariate as baseline information leads to time-dependent bias, which artificially inflates the protective effect and damps down the harmful effect of that covariate [14,23]. We also found that BED was not significantly associated with survival; this finding is in line with past studies that did not find dose-response relationship in terms of survival [5,24,25]. Absence of dose-response relationship further supports the hypothesis that radiotherapy does not significantly improve survival of these patients.…”

Section: Discussionsupporting

confidence: 90%

“…Bleeding from gastric cancer is a burdensome complication, which may require blood transfusion and hospitalization [4]. Palliative surgery is an effective treatment for bleeding, but is often difficult for elderly patients and those with a poor performance status [5]. Bulky primary tumors and/or metastatic lymph nodes that involve other organs may also sometimes hamper the palliative surgery.…”

Section: Introductionmentioning

confidence: 99%

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Treatment response after palliative radiotherapy for bleeding gastric cancer: a multicenter prospective observational study (JROSG 17-3)

et al. 2021

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Background Palliative radiotherapy seems to be rarely performed for incurable gastric cancer. In this first multicenter study, we examined the effectiveness of palliative radiotherapy and investigated whether biologically effective dose (BED) is associated with survival, response, or re-bleeding. Methods Eligibility criteria included blood transfusion or hemoglobin levels < 8.0 g/dL. The primary endpoint was the intention-to-treat (ITT) bleeding response rate at 4 weeks. Response entailed all of the following criteria: (i) hemoglobin levels ≥ 8.0 g/dL; (ii) 7 consecutive days without blood transfusion anytime between enrollment and blood sampling; and (iii) no salvage treatment (surgery, endoscopic treatment, transcatheter embolization, or re-irradiation) for bleeding gastric cancer. Re-bleeding was defined as the need for blood transfusion or salvage treatment. ResultsWe enrolled 55 patients from 15 institutions. The ITT response rates were 47%, 53%, and 49% at 2, 4, and 8 weeks, respectively. The per-protocol response rates were 56%, 78%, and 90% at 2, 4, and 8 weeks, respectively. Neither response nor BED (α/β = 10) predicted overall survival. Multivariable Fine-Gray model showed that BED was not a significant predictor of response. Univariable Cox model showed that BED was not significantly associated with re-bleeding. Grades 1, 2, 3, and, ≥ 4 radiation-related adverse events were reported in 11, 9, 1, and 0 patients, respectively. Conclusions The per-protocol response rate increased to 90% during the 8-week follow-up. The frequent occurrence of death starting shortly after enrollment lowered the ITT response rate. BED was not associated with survival, bleeding response, or re-bleeding.

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Section: Discussionsupporting

confidence: 90%

Section: Introductionmentioning

confidence: 99%

Treatment response after palliative radiotherapy for bleeding gastric cancer: a multicenter prospective observational study (JROSG 17-3)

et al. 2021

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“…The PubMed database was searched for relevant literature published in the English language for the period between 2017 and 2021 using related key words (e.g., ‘GC’, ‘bleeding’ and ‘RT’) ( Figure 4 ). We identified nine published studies that reported the outcomes of palliative RT for GC bleeding [ 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 ]; these are summarized in Table 2 and Table 3 .…”

Section: Discussionmentioning

confidence: 99%

“…GC often induces bleeding from the primary site, which not only compromises the quality of life but also occasionally results in a life-threatening condition. Several treatment modalities for bleeding GC can be considered, including palliative surgical resection [ 4 ], endoscopic hemostasis [ 5 , 6 ], transcatheter embolotherapy [ 7 ] and radiotherapy (RT) [ 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 ]. The treatment strategy should be considered based on their strong and weak points, the patient’s general condition and the local bleeding status [ 17 ].…”

Section: Introductionmentioning

confidence: 99%

“…RT with a total of 6–60 Gy irradiation may be indicated, even for patients in a poor general condition and for various types of bleeding, which can successfully control tumor bleeding in 55–88% of patients without severe toxicity [ 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 ]. Radiation gives rise to denudation of the surface of blood vessels, leading to thrombosis and capillary necrosis as the result of acute damage [ 18 , 19 ].…”

Section: Introductionmentioning

confidence: 99%

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Palliative Radiotherapy for Bleeding from Unresectable Gastric Cancer Using Three-Dimensional Conformal Technique

Kawabata¹,

Fujii²,

Yamamoto³

et al. 2022

Biomedicines

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Optimal regimens using recent radiotherapy (RT) equipment for bleeding gastric cancer (GC) have not been fully investigated yet. We retrospectively reviewed the clinical data of 20 patients who received RT for bleeding GC in our institution between 2016 and 2021. Three-dimensional conformal RT was performed. The effectiveness of RT was evaluated by the mean serum hemoglobin (Hb) level and the number of transfused red blood cell (RBC) units 1 month before and after RT. The median first radiation dose was a BED of 39.9 Gy. The treatment success rate was 95% and the rebleeding rate was 10.5%. There was a significant increase in the mean Hb level (8.0 ± 1.1 vs. 9.8 ± 1.3 g/dL, p = 0.01), and a significant decrease in the mean number of transfused RBC units (6.8 ± 3.3 vs. 0.6 ± 1.5 units, p < 0.01). Severe toxicity was observed in two patients (anorexia [n = 1] and gastrointestinal [GI] perforation [n = 1]). Reirradiation was attempted in three patients (for hemostasis [n = 2] and for mass reduction [n = 1]). The retreatment success rate for rebleeding was 100%. GI perforation occurred in two patients who had received hemostatic reirradiation. Palliative RT for bleeding GC using recent technology had excellent efficacy. However, it may be associated with a risk of GI perforation.

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Hemostatic palliative radiotherapy for gastric cancer: A literature review

Tanaka

2024

Technical Innovations & Patient Support in Radiation Oncolo

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Verification of the Utility of Palliative Radiotherapy for Hemostasis of Gastric Cancer Bleeding: a Case Control Study

Cited by 6 publications

References 16 publications

Treatment response after palliative radiotherapy for bleeding gastric cancer: a multicenter prospective observational study (JROSG 17-3)

Treatment response after palliative radiotherapy for bleeding gastric cancer: a multicenter prospective observational study (JROSG 17-3)

Palliative Radiotherapy for Bleeding from Unresectable Gastric Cancer Using Three-Dimensional Conformal Technique

Hemostatic palliative radiotherapy for gastric cancer: A literature review

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