Kawabata Hideaki, Hitomi Misuzu, Motoi Shigehiro
Department of Gastroenterology, Kyoto Okamoto Memorial Hospital, 100 Nishinokuchi, Sayama, Kumiyama-cho, Kuze-gun, Kyoto 613-0034, Japan.
Biomedicines. 2019 Jul 24;7(3):54. doi: 10.3390/biomedicines7030054.
Bleeding from unresectable gastric cancer (URGC) is not a rare complication. Two major ways in which the management of this issue differs from the management of benign lesions are the high rate of rebleeding after successful hemostasis and that not only endoscopic therapy (ET) and transcatheter arterial embolization (TAE) but palliative radiotherapy (PRT) can be applied in the clinical setting. However, there are no specific guidelines concerning the management of URGC with bleeding. We herein discuss strategies for managing bleeding from URGC. A high rate of initial hemostasis for active bleeding is expected when using various ET modalities properly. If ET fails in patients with hemostatic instability, emergent TAE is considered in order to avoid a life-threating condition due to massive bleeding. Early PRT, especially, regimens with a high biologically effective dose (BED) of ≥39 Gy should be considered not only for patients with hemostatic failure but also for those with successful hemostasis and inactive hemorrhage, as longer duration of response with few complications can be expected. Further prospective, comparative studies considering not only the hemostatic efficacy of these modalities but the patients' quality of life are needed in order to establish treatment strategies for bleeding from URGC.
不可切除胃癌（URGC）出血并非罕见并发症。该问题的处理与良性病变处理的两个主要不同之处在于，成功止血后再出血率高，且在临床环境中不仅可应用内镜治疗（ET）和经导管动脉栓塞术（TAE），还可应用姑息性放疗（PRT）。然而，对于URGC出血的处理尚无具体指南。我们在此讨论URGC出血的处理策略。正确使用各种ET方式时，有望对活动性出血实现较高的初始止血率。如果止血不稳定的患者ET失败，应考虑紧急TAE，以避免因大出血导致危及生命的情况。早期PRT，尤其是生物等效剂量（BED）≥39 Gy的高剂量方案，不仅应考虑用于止血失败的患者，也应考虑用于止血成功且无活动性出血的患者，因为有望获得更长的缓解期且并发症较少。为了确立URGC出血的治疗策略，需要开展进一步的前瞻性比较研究，不仅要考虑这些方式的止血效果，还要考虑患者的生活质量。
