Department of Radiation Oncology, Bern University Hospital, and University of Bern, Bern, Switzerland.
Radiat Oncol. 2012 Aug 3;7:132. doi: 10.1186/1748-717X-7-132.
This study was performed to evaluate the outcome after hemostatic radiotherapy (RT) of significant bleeding in incurable cancer patients.
Patients treated by hemostatic RT between November 2006 and February 2010 were retrospectively analyzed. Bleeding was assessed according to the World Health Organization (WHO) scale (grade 0 = no bleeding, 1 = petechial bleeding, 2 = clinically significant bleeding, 3 = bleeding requiring transfusion, 4 = bleeding associated with fatality). The primary endpoint was bleeding at the end of RT. Key secondary endpoints included overall survival (OS) and acute toxicity. The bleeding score before and after RT were compared using the Wilcoxon signed rank test. Time to event endpoints were estimated using the Kaplan Meier method.
Overall 62 patients were analyzed including 1 patient whose benign cause of bleeding was pseudomyxoma peritonei. Median age was 66 (range, 37-93) years. Before RT, bleeding was graded as 2 and 3 in 24 (39%) and 38 (61%) patients, respectively. A median dose of 20 (range, 5-45) Gy of hemostatic RT was applied to the bleeding site. At the end of RT, there was a statistically significant difference in bleeding (p < 0.001); it was graded as 0 ( n = 39), 1 ( n = 12), 2 ( n = 6), 3 ( n = 4) and 4 (n = 1). With a median follow-up of 19.3 (range, 0.3-19.3) months, the 6-month OS rate was 43%. Forty patients died (65%); 5 due to bleeding. No grade 3 or above acute toxicity was observed.
Hemostatic RT seems to be a safe and effective treatment for clinically and statistically significantly reducing bleeding in incurable cancer patients.
本研究旨在评估不可治愈癌症患者大量出血时进行止血放疗（RT）的治疗效果。
回顾性分析 2006 年 11 月至 2010 年 2 月期间接受止血 RT 治疗的患者。出血情况根据世界卫生组织（WHO）量表进行评估（0 级=无出血，1 级=瘀点出血，2 级=临床显著出血，3 级=需要输血的出血，4 级=与死亡相关的出血）。主要终点为 RT 结束时的出血情况。关键次要终点包括总生存期（OS）和急性毒性。采用 Wilcoxon 符号秩检验比较 RT 前后的出血评分。使用 Kaplan-Meier 方法估计事件时间终点。
共分析了 62 例患者，其中 1 例良性出血原因为腹膜假黏液瘤。中位年龄为 66 岁（范围，37-93 岁）。RT 前，24 例（39%）和 38 例（61%）患者的出血分级分别为 2 级和 3 级。止血 RT 的中位剂量为 20 Gy（范围，5-45 Gy），应用于出血部位。RT 结束时，出血情况有统计学显著差异（p<0.001）；0 级（n=39）、1 级（n=12）、2 级（n=6）、3 级（n=4）和 4 级（n=1）的患者分别有 39 例、12 例、6 例、4 例和 1 例。中位随访时间为 19.3 个月（范围，0.3-19.3 个月），6 个月 OS 率为 43%。40 例患者死亡（65%），其中 5 例死于出血。未观察到 3 级或以上急性毒性。
止血 RT 似乎是一种安全有效的治疗方法，可显著减少不可治愈癌症患者的临床出血。
