Hamasaki Taro, Takeda Shigeru, Iida Michihisa, Kanekiyo Shinsuke, Nishiyama Mitsuo, Nakashima Chiyo, Shindo Yoshitaro, Tokumitsu Yukio, Tomochika Shinobu, Yoshida Shin, Suzuki Nobuaki, Hazama Shoichi, Yoshino Shigefumi, Ioka Tatsuya, Nagano Hiroaki
Dept. of Gastroenterological, Breast and Endocrine Surgery, Yamaguchi University Graduate School of Medicine.
Gan To Kagaku Ryoho. 2020 Dec;47(13):2364-2366.
Case 1: The patient was a 74-year-old man with a performance status(PS)of 0. He was referred to our department for pyloric gastric cancer with multiple liver, lung, and lymph node metastases. We started chemotherapy after making the diagnosis of an unresectable gastric cancer. During chemotherapy, the hemoglobin level dropped due to bleeding from the tumor. We attempted endoscopic hemostasis, which was not successful; therefore, we attempted a palliative radiotherapy. The total dose was 30 Gy in 10 Fr and hemostasis was achieved on the 10th day from the start of the radiotherapy. There were no adverse events due to the radiation, and the chemotherapy could be restarted 5 days after the end of the radiotherapy. Case 2: The patient was a 78-year-old man with a PS of 2. He was referred to our department because of vomiting and anemia. As a result of a close inspection, we made the diagnosis of an unresectable gastric body cancer with para-aortic lymph node metastasis and peritoneal dissemination, for which chemotherapy was initiated. Anemia was observed at the first visit, and we started radiotherapy to stop the tumor bleeding. The total dose was 30 Gy in 10 Fr, and hemostasis was achieved on the 12th day. There were no adverse events during the radiotherapy, and chemotherapy could be continued. Palliative radiotherapy is an available method of hemostasis that is less invasive than surgery or transcatheter arterial embolization and can be expected to have a certain effect for gastric cancer bleeding, although it takes several days to obtain a therapeutic effect.
病例1：患者为一名74岁男性，体能状态（PS）为0。因幽门部胃癌伴多发肝、肺及淋巴结转移被转诊至我科。在诊断为不可切除的胃癌后开始化疗。化疗期间，因肿瘤出血导致血红蛋白水平下降。我们尝试了内镜止血，但未成功；因此，我们尝试了姑息性放疗。总剂量为30 Gy，分10次照射，放疗开始后第10天实现了止血。放疗未引起不良事件，放疗结束5天后可重新开始化疗。病例2：患者为一名78岁男性，PS为2。因呕吐和贫血被转诊至我科。经仔细检查，诊断为不可切除的胃体癌伴主动脉旁淋巴结转移和腹膜播散，为此开始化疗。初诊时发现贫血，我们开始放疗以止血。总剂量为30 Gy，分10次照射，第12天实现了止血。放疗期间未出现不良事件，化疗可继续进行。姑息性放疗是一种可行的止血方法，其侵入性低于手术或经导管动脉栓塞术，尽管需要数天才能获得治疗效果，但对胃癌出血有望产生一定效果。
