The role of palliative radiotherapy for haemostasis in unresectable gastric cancer: a single-institution experience

Abstract

Purpose: To evaluate the outcomes of patients with gastric cancer bleeding who had been treated with palliative radiotherapy with haemostatic intent.

Methods and materials: Fifty-two gastric cancer patients aged 52-92 years (median 78 years) with active bleeding or anaemia resulting from inoperable gastric cancer were treated with short-course radiotherapy. Responses to radiotherapy treatment were evaluated based on the changes of haemoglobin level, number of transfusions received before and after radiotherapy, and overall median survival.

Results: Thirty-nine (75%) patients received single 8 Gy fraction, and 13 (25%) patients received 20 Gy in five daily fractions. The need for transfusion was evaluable in 44 patients, and the response rate was 50%, with less requirement for blood transfusions within four weeks of radiotherapy. There was also an increase in mean haemoglobin level (0.66 ± 1.12 g/dl, p < 0.01) after radiotherapy in 35 evaluable patients. The overall median survival (calculated from last day of treatment to date of death) was 160 days (95% CI of 119-201 days), making actuarial 12-month survival 15%.

Conclusion: Palliative short-course radiotherapy is a reasonably effective treatment that can provide durable palliation of bleeding in gastric cancer.

Keywords: bleeding; gastric cancer; haemostasis; palliative; radiotherapy.

Figure 1.. Differences in mean haemoglobin level before and after palliative radiotherapy in 35 patients. Twenty-six patients had an increase in mean haemoglobin level after treatment, whereas nine patients had a fall. The overall increment in mean haemoglobin level was 0.66 ±1.12g/dl in 35 patients, p < 0.01.

Figure 2.. Kaplan–Meier survival curve of 52 patients receiving palliative radiotherapy. The overall median survival of these patients was 160 days (95% CI 119–201 days). Four patients were alive and censored at the time of analysis.