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Efficacy of palliative radiotherapy for gastric bleeding in patients with unresectable advanced gastric cancer: a retrospective cohort study.

Kondoh C, Shitara K, Nomura M, Takahari D, Ura T, Tachibana H, Tomita N, Kodaira T, Muro K - BMC Palliat Care (2015)

Bottom Line: The median total planned radiation dose was 30 Gy in 10 fractions.The median volume of red blood cell transfusion was significantly decreased from 1120 to 280 mL (p = 0.007).The median rebleeding-free survival interval was 27 days, with a median overall survival of 63 days.

View Article: PubMed Central - PubMed

Affiliation: Department of Clinical Oncology, Aichi Cancer Center Hospital, 1-1 Kanoko-den Chikusa-ku, Nagoya City, Aichi, Japan. hirochi1981@gmail.com.

ABSTRACT

Background: Bleeding negatively impacts quality of life in patients with unresectable advanced gastric cancer and has the potential to be lethal. When blood transfusion and endoscopic hemostasis are unsuccessful to stop bleeding, radiation to stomach is selected in patients with unsuitable condition for surgery. We performed a retrospective cohort study to clarify the utility of radiotherapy in treating gastric bleeding, particularly for patients with limited life expectancy.

Methods: We evaluated the efficacy and safety of palliative radiotherapy in patients with advanced gastric cancer between January 2007 and December 2012 in Aichi Cancer Center Hospital. All patients had gastric bleeding requiring blood transfusion. We defined hemostasis as an increase in hemoglobin level to more than 7.0 g/dL together with the cessation of melena or hematemesis for at least 1 week.

Results: During the study period, 313 advanced gastric cancer patients treated in our institution. Of these 17 patients received gastric radiotherapy to stop bleeding. Two patients were excluded from analysis due to combined treatment of intravascular embolization. Eleven out of 15 patients (73 %) had undergone two or more previous chemotherapy regimens. Ten patients (67 %) had an Eastern Cooperative Oncology Group performance status of 3 and 14 patients (93 %) were in palliative prognostic index group B or C. The median total planned radiation dose was 30 Gy in 10 fractions. At a median interval of 2 days after initiation of radiotherapy, 11 patients (73 %) achieved hemostasis; rebleeding was observed in four patients (36 %). The median hemoglobin level before radiotherapy was significantly increased from 6.0 to 9.0 g/dL (p < 0.0001). The median volume of red blood cell transfusion was significantly decreased from 1120 to 280 mL (p = 0.007). The median rebleeding-free survival interval was 27 days, with a median overall survival of 63 days. The cause of death was bleeding in 1 patient (7 %) and cancer progression without bleeding in 12 patients (80 %). There were no severe adverse events attributable to radiotherapy.

Conclusions: Palliative radiotherapy for gastric bleeding achieves hemostasis within a short time frame. This appears to be a useful treatment option, especially for patients with end-stage, unresectable advanced gastric cancer.

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Rebleeding-free survival (RFS) and overall survival (OS) after gastric radiation therapy
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Fig2: Rebleeding-free survival (RFS) and overall survival (OS) after gastric radiation therapy

Mentions: Eleven patients (73 %) achieved hemostasis. The median time to hemostasis was 2 days (range, 1–9 days). The median hemostatic radiation dose was 6 Gy (range, 3–21 Gy). In the four patients categorized as no hemostasis, no one started RT with thrombocytopenia. Three patients received RT alone and one patient received chemoRT. One patient was rescued by arterial embolization technique and stopped bleeding. None was performed endoscopic procedures. The median hemoglobin level before RT was 6.0 g/dL; after 30 days, the median was 9.0 g/dL, a significant increase (p < 0.001). The median platelet count was 291,000/mm3 (range, 6.0–53.3) on the day of starting RT. The median red blood cell transfusion volume per month significantly decreased, from 1120 mL pre-RT to 280 mL after starting RT (p = 0.007) (Fig. 1). In the 11 patients who achieved hemostasis, 4 experienced rebleeding (36 %). At the time of rebleeding, the platelet count less than 50,000/mm3 was observed in one patient with disseminated intravascular coagulopathy due to bone marrow metastasis. The median RFS was 27 days (95 % confidential interval [CI], 1–94 days) (Fig. 2).Fig. 1


Efficacy of palliative radiotherapy for gastric bleeding in patients with unresectable advanced gastric cancer: a retrospective cohort study.

Kondoh C, Shitara K, Nomura M, Takahari D, Ura T, Tachibana H, Tomita N, Kodaira T, Muro K - BMC Palliat Care (2015)

Rebleeding-free survival (RFS) and overall survival (OS) after gastric radiation therapy
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4524128&req=5

Fig2: Rebleeding-free survival (RFS) and overall survival (OS) after gastric radiation therapy
Mentions: Eleven patients (73 %) achieved hemostasis. The median time to hemostasis was 2 days (range, 1–9 days). The median hemostatic radiation dose was 6 Gy (range, 3–21 Gy). In the four patients categorized as no hemostasis, no one started RT with thrombocytopenia. Three patients received RT alone and one patient received chemoRT. One patient was rescued by arterial embolization technique and stopped bleeding. None was performed endoscopic procedures. The median hemoglobin level before RT was 6.0 g/dL; after 30 days, the median was 9.0 g/dL, a significant increase (p < 0.001). The median platelet count was 291,000/mm3 (range, 6.0–53.3) on the day of starting RT. The median red blood cell transfusion volume per month significantly decreased, from 1120 mL pre-RT to 280 mL after starting RT (p = 0.007) (Fig. 1). In the 11 patients who achieved hemostasis, 4 experienced rebleeding (36 %). At the time of rebleeding, the platelet count less than 50,000/mm3 was observed in one patient with disseminated intravascular coagulopathy due to bone marrow metastasis. The median RFS was 27 days (95 % confidential interval [CI], 1–94 days) (Fig. 2).Fig. 1

Bottom Line: The median total planned radiation dose was 30 Gy in 10 fractions.The median volume of red blood cell transfusion was significantly decreased from 1120 to 280 mL (p = 0.007).The median rebleeding-free survival interval was 27 days, with a median overall survival of 63 days.

View Article: PubMed Central - PubMed

Affiliation: Department of Clinical Oncology, Aichi Cancer Center Hospital, 1-1 Kanoko-den Chikusa-ku, Nagoya City, Aichi, Japan. hirochi1981@gmail.com.

ABSTRACT

Background: Bleeding negatively impacts quality of life in patients with unresectable advanced gastric cancer and has the potential to be lethal. When blood transfusion and endoscopic hemostasis are unsuccessful to stop bleeding, radiation to stomach is selected in patients with unsuitable condition for surgery. We performed a retrospective cohort study to clarify the utility of radiotherapy in treating gastric bleeding, particularly for patients with limited life expectancy.

Methods: We evaluated the efficacy and safety of palliative radiotherapy in patients with advanced gastric cancer between January 2007 and December 2012 in Aichi Cancer Center Hospital. All patients had gastric bleeding requiring blood transfusion. We defined hemostasis as an increase in hemoglobin level to more than 7.0 g/dL together with the cessation of melena or hematemesis for at least 1 week.

Results: During the study period, 313 advanced gastric cancer patients treated in our institution. Of these 17 patients received gastric radiotherapy to stop bleeding. Two patients were excluded from analysis due to combined treatment of intravascular embolization. Eleven out of 15 patients (73 %) had undergone two or more previous chemotherapy regimens. Ten patients (67 %) had an Eastern Cooperative Oncology Group performance status of 3 and 14 patients (93 %) were in palliative prognostic index group B or C. The median total planned radiation dose was 30 Gy in 10 fractions. At a median interval of 2 days after initiation of radiotherapy, 11 patients (73 %) achieved hemostasis; rebleeding was observed in four patients (36 %). The median hemoglobin level before radiotherapy was significantly increased from 6.0 to 9.0 g/dL (p < 0.0001). The median volume of red blood cell transfusion was significantly decreased from 1120 to 280 mL (p = 0.007). The median rebleeding-free survival interval was 27 days, with a median overall survival of 63 days. The cause of death was bleeding in 1 patient (7 %) and cancer progression without bleeding in 12 patients (80 %). There were no severe adverse events attributable to radiotherapy.

Conclusions: Palliative radiotherapy for gastric bleeding achieves hemostasis within a short time frame. This appears to be a useful treatment option, especially for patients with end-stage, unresectable advanced gastric cancer.

Show MeSH
Related in: MedlinePlus