Hemostatic Effect of Palliative Radiation Therapy in Preventing Blood Transfusions from Bleeding Occurring within Advanced Gastric Cancer.

Purpose:To report the hemostatic effects of palliative radiation therapy (RT) for the prevention of blood transfusions (BT) in patients with advanced gastric cancer (AGC). Methods and Materials: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. Results: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)10 of 39 Gy (30 Gy in 10 fractions) (78%) compared with six patients treated with a BED10 of 48 Gy (40 Gy in 20 fractions) (25%). Grade 1 and 2 nausea (n = 11) and a Grade 2 increase in alanine aminotransferase (n = 1) were observed. One patient died of Grade 5 hemorrhage. Conclusions: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 BED10 of 39 Gy) has a more durable hemostatic effect and thus should be considered for better prognosis.