Clinical outcome of palliative radiotherapy for locally advanced symptomatic gastric cancer in the modern era.
The purpose of this study was to report the outcomes of patients with symptomatic locally advanced/recurrent gastric cancer treated with radiotherapy (RT) using modern 3-dimensional conformal techniques.We retrospectively reviewed patients who had palliative RT for index symptoms of gastric bleeding, pain, and obstruction. Study endpoints included symptom response, median survival, and treatment toxicity.Of 115 patients with median age of 77 years, 78 (67.8%) patients had metastatic disease at the time of treatment. Index symptoms were gastric bleeding, pain, and obstruction in 89.6%, 9.2%, and 14.3% of patients, respectively. Dose fractionation regimen ranged from 8-Gy single fraction to 40 Gy in 16 fractions. One hundred eleven patients (93.3%) were computed tomography (CT) planned. Median follow-up was 85 days. Response rates for bleeding, pain, and obstruction were 80.6% (83/103), 45.5% (5/11), and 52.9% (9/17), respectively, and median duration of response was 99 days, 233 days, and 97 days, respectively. Median survival was 85 days. Actuarial 12-month survival was 15.3%. There was no difference in response rates between low (≤39 Gy) and high (>39 Gy) biologically effective dose (BED) regimens (α/β ratio = 10). Median survival was significantly longer in patients who responded to RT compared with patients who did not (113.5 vs 47 days, P < 0.001). Three patients (2.6%) had grade 3 Common Toxicity Criteria equivalent toxicity (nausea/vomiting/anorexia).External beam RT delivered using 3-dimensional conformal techniques is highly effective and well tolerated in the local palliation of gastric cancer, with palliation lasting the majority of patient's lives. Short (≤39 Gy BED) RT schedules are adequate for effective symptom palliation. A phase II study of palliative gastric RT is ongoing.
Department of Radiation Oncology (CNL, LCW, KL, JJL, WYK), National University Hospital; Department of Radiation Oncology (JT, BAC, CNL, LCW, KL, JJL, WYK), Tan Tock Seng Hospital, National Cancer Institute of Singapore; and Health Promotion Board (EYL), Singapore.
Jeremy
J
Tey
Bok Ai
BA
Choo
Cheng Nang
CN
Leong
En Yun
EY
Loy
Lea Choung
LC
Wong
Keith
K
Lim
Jiade Jay
JJ
Lu
Wee Yao
WY
Koh
D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology / Q000532:radiotherapy*; D009367:Neoplasm Staging; D010166:Palliative Care; D020266:Radiotherapy, Conformal; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000473:pathology / Q000532:radiotherapy*; D016896:Treatment Outcome