Kosugi Takashi, Shikama Naoto, Saito Tetsuo, Nakamura Naoki, Nakura Ayako, Harada Hideyuki, Wada Hitoshi, Nozaki Miwako, Uchida Nobue, Nakamura Katsumasa
Department of Radiation Oncology, Fujieda Municipal General Hospital, Fujieda, Shizuoka, Japan.
Department of Radiation Oncology, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan.
World J Oncol. 2016 Jun;7(2-3):29-33. doi: 10.14740/wjon977w. Epub 2016 Jul 1.
In end-stage cancer, bleeding may markedly influence the patient's quality of life, and radiotherapy plays an important role in the control of the bleeding. In particular, there is no clear evidence of the benefit of palliative radiotherapy for cancers including gastric, rectal, and bladder cancers. A clarification of the current status of palliative radiotherapy for bleeding is needed.
A survey was conducted by the palliative radiotherapy working group of the Japanese Radiation Oncology Study Group (JROSG), focusing on annual cases of radiotherapy for tumors of the upper and lower gastrointestinal tracts and genitourinary organs (excluding the uterus) and applicable fractionated doses for three hypothetical patients.
A total of 54 radiation oncologists at 43 facilities answered. Most of the facilities reported that they conducted hemostatic irradiation for less than one patient per year, though the median annual number of patients treated with radiotherapy in these facilities was 594. The most frequently observed doses per fraction for two of the hypothetical cases were 3.0 and 2.0 Gy. On the other hand, in each case, the numbers of fractions reported varied markedly among the respondents, ranging from 20 Gy in five fractions to over 30 fractions.
Especially in gastric cancer, hemostatic irradiation is rarely performed in most facilities in Japan. An optimal dose fractionation has not been established. Thirty Gy in 10 fractions is one of the most frequently used regimens, but re-bleeding was observed in approximately one-third of the patients.
在晚期癌症中，出血可能会显著影响患者的生活质量，而放射治疗在控制出血方面发挥着重要作用。特别是，对于胃癌、直肠癌和膀胱癌等癌症，尚无明确证据表明姑息性放疗有益。因此，需要明确姑息性放疗治疗出血的现状。
日本放射肿瘤学研究组（JROSG）的姑息性放疗工作组进行了一项调查，重点关注上、下消化道及泌尿生殖器官（不包括子宫）肿瘤的年度放疗病例以及三名假设患者适用的分次剂量。
43家机构的54名放射肿瘤学家进行了回复。大多数机构报告称，他们每年进行止血放疗的患者少于1例，尽管这些机构每年接受放疗的患者中位数为594例。在两个假设病例中，最常观察到的每次分割剂量为3.0 Gy和2.0 Gy。另一方面，在每个病例中，不同受访者报告的分割次数差异显著，从5次分割共20 Gy到超过30次分割不等。
特别是在日本的大多数机构中，胃癌的止血放疗很少进行。尚未确定最佳的剂量分割方案。10次分割共30 Gy是最常用的方案之一，但约三分之一的患者出现了再次出血。
