Mitsuhashi Norio, Ikeda Hajime, Nemoto Yoshitaka, Kuronuma Mayumi, Kamiga Masahiro, Hiroshima Yoshinori
Cancer Board Division, Radiation Therapy Center, Hitachinaka General Hospital, Hitachinaka, Ibaraki, Japan.
Department of Palliative Care, amd Hitachinaka General Hospital, Hitachinaka, Ibaraki, Japan.
Palliat Med Rep. 2021 Dec 22;2(1):355-364. doi: 10.1089/pmr.2021.0041. eCollection 2021.
To report the hemostatic effects of palliative radiation therapy (RT) for the prevention of blood transfusions (BT) in patients with advanced gastric cancer (AGC).
Twenty-eight patients who received palliative three-dimensional conformal RT for hemostasis of gastric bleeding were retrospectively assessed in a study conducted in Japan. The median follow-up was 143.5 days. Changes in hemoglobin (Hb) levels were compared at the beginning of RT and four weeks later. Blood transfusion-free survival (BTFS) and overall survival (OS) were measured from the beginning of RT. Treatment toxicity was evaluated within 60 days of RT initiation.
No statistically significant decrease in Hb level was observed four weeks after RT. Twenty-eight patients did not receive BT within a month after RT, of whom three died within a month; 6/28 patients (21%) received BT at a median interval of 99.5 days following RT. The one-year BTFS and OS rates for all patients were 69% and 12%, respectively. The one-year BTFS was statistically significantly higher in 17 patients treated with a biologically effective dose (BED) of 39 Gy (30 Gy in 10 fractions) (78%) compared with six patients treated with a BED of 48 Gy (40 Gy in 20 fractions) (25%). Grade 1 and 2 nausea ( = 11) and a Grade 2 increase in alanine aminotransferase ( = 1) were observed. One patient died of Grade 5 hemorrhage.
Palliative RT is an effective treatment to prevent BT for bleeding occurring within AGC. Specifically, a fractionation regimen of 30 Gy in 10 fractions (a BED of 39 Gy) has a more durable hemostatic effect and thus should be considered for better prognosis.
报告姑息性放射治疗（RT）对晚期胃癌（AGC）患者预防输血（BT）的止血效果。
在日本进行的一项研究中，对28例因胃出血接受姑息性三维适形RT的患者进行了回顾性评估。中位随访时间为143.5天。比较RT开始时和四周后的血红蛋白（Hb）水平变化。从RT开始测量无输血生存期（BTFS）和总生存期（OS）。在RT开始后60天内评估治疗毒性。
RT四周后未观察到Hb水平有统计学意义的下降。28例患者在RT后一个月内未接受BT，其中3例在一个月内死亡；6/28例患者（21%）在RT后中位间隔99.5天接受了BT。所有患者的一年BTFS和OS率分别为69%和12%。与6例接受48 Gy生物等效剂量（BED）（20次分割，每次40 Gy）治疗的患者相比，17例接受39 Gy BED（10次分割，每次30 Gy）治疗的患者一年BTFS在统计学上显著更高（78%）。观察到1级和2级恶心（n = 11）以及1例2级丙氨酸转氨酶升高。1例患者死于5级出血。
姑息性RT是预防AGC内出血导致BT的有效治疗方法。具体而言，10次分割给予30 Gy（BED为39 Gy）的分割方案具有更持久的止血效果，因此应考虑采用以获得更好的预后。
