title: Clinically significant bleeding in incurable cancer patients: effectiveness of hemostatic radiotherapy.
abstract: BACKGROUND
  This study was performed to evaluate the outcome after hemostatic radiotherapy (RT) of significant bleeding in incurable cancer patients.
  
  
  METHODS
  Patients treated by hemostatic RT between November 2006 and February 2010 were retrospectively analyzed. Bleeding was assessed according to the World Health Organization (WHO) scale (grade 0 = no bleeding, 1 = petechial bleeding, 2 = clinically significant bleeding, 3 = bleeding requiring transfusion, 4 = bleeding associated with fatality). The primary endpoint was bleeding at the end of RT. Key secondary endpoints included overall survival (OS) and acute toxicity. The bleeding score before and after RT were compared using the Wilcoxon signed rank test. Time to event endpoints were estimated using the Kaplan Meier method.
  
  
  RESULTS
  Overall 62 patients were analyzed including 1 patient whose benign cause of bleeding was pseudomyxoma peritonei. Median age was 66 (range, 37-93) years. Before RT, bleeding was graded as 2 and 3 in 24 (39%) and 38 (61%) patients, respectively. A median dose of 20 (range, 5-45) Gy of hemostatic RT was applied to the bleeding site. At the end of RT, there was a statistically significant difference in bleeding (p < 0.001); it was graded as 0 ( n = 39), 1 ( n = 12), 2 ( n = 6), 3 ( n = 4) and 4 (n = 1). With a median follow-up of 19.3 (range, 0.3-19.3) months, the 6-month OS rate was 43%. Forty patients died (65%); 5 due to bleeding. No grade 3 or above acute toxicity was observed.
  
  
  CONCLUSIONS
  Hemostatic RT seems to be a safe and effective treatment for clinically and statistically significantly reducing bleeding in incurable cancer patients.
authors.affiliation: Department of Radiation Oncology, Bern University Hospital, and University of Bern, Bern, Switzerland.
authors.forename: Nikola
authors.initials: N
authors.lastname: Cihoric
authors.forename: Susanne
authors.initials: S
authors.lastname: Crowe
authors.forename: Steffen
authors.initials: S
authors.lastname: Eychmüller
authors.forename: Daniel M
authors.initials: DM
authors.lastname: Aebersold
authors.forename: Pirus
authors.initials: P
authors.lastname: Ghadjar
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy / Q000379:methods; D005260:Female; D006470:Hemorrhage / Q000209:etiology / Q000532:radiotherapy*; D006487:Hemostasis / Q000528:radiation effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications / Q000401:mortality / Q000532:radiotherapy*; D010166:Palliative Care / Q000379:methods; D012189:Retrospective Studies; D019452:Terminally Ill; D016896:Treatment Outcome