title: Efficacy of palliative radiotherapy for gastric bleeding in patients with unresectable advanced gastric cancer: a retrospective cohort study.
abstract: BACKGROUND
  Bleeding negatively impacts quality of life in patients with unresectable advanced gastric cancer and has the potential to be lethal. When blood transfusion and endoscopic hemostasis are unsuccessful to stop bleeding, radiation to stomach is selected in patients with unsuitable condition for surgery. We performed a retrospective cohort study to clarify the utility of radiotherapy in treating gastric bleeding, particularly for patients with limited life expectancy.
  
  
  METHODS
  We evaluated the efficacy and safety of palliative radiotherapy in patients with advanced gastric cancer between January 2007 and December 2012 in Aichi Cancer Center Hospital. All patients had gastric bleeding requiring blood transfusion. We defined hemostasis as an increase in hemoglobin level to more than 7.0 g/dL together with the cessation of melena or hematemesis for at least 1 week.
  
  
  RESULTS
  During the study period, 313 advanced gastric cancer patients treated in our institution. Of these 17 patients received gastric radiotherapy to stop bleeding. Two patients were excluded from analysis due to combined treatment of intravascular embolization. Eleven out of 15 patients (73 %) had undergone two or more previous chemotherapy regimens. Ten patients (67 %) had an Eastern Cooperative Oncology Group performance status of 3 and 14 patients (93 %) were in palliative prognostic index group B or C. The median total planned radiation dose was 30 Gy in 10 fractions. At a median interval of 2 days after initiation of radiotherapy, 11 patients (73 %) achieved hemostasis; rebleeding was observed in four patients (36 %). The median hemoglobin level before radiotherapy was significantly increased from 6.0 to 9.0 g/dL (p < 0.0001). The median volume of red blood cell transfusion was significantly decreased from 1120 to 280 mL (p = 0.007). The median rebleeding-free survival interval was 27 days, with a median overall survival of 63 days. The cause of death was bleeding in 1 patient (7 %) and cancer progression without bleeding in 12 patients (80 %). There were no severe adverse events attributable to radiotherapy.
  
  
  CONCLUSIONS
  Palliative radiotherapy for gastric bleeding achieves hemostasis within a short time frame. This appears to be a useful treatment option, especially for patients with end-stage, unresectable advanced gastric cancer.
authors.affiliation: Department of Clinical Oncology, Aichi Cancer Center Hospital, 1-1 Kanoko-den Chikusa-ku, Nagoya City, Aichi, Japan. hirochi1981@gmail.com.|Department of Medical Oncology, Japanese Red Cross Nagoya Daiichi Hospital, 3-35 Michishita-Cho, Nakamura-ku, Nagoya City, Aichi, Japan. hirochi1981@gmail.com.
authors.forename: Chihiro
authors.initials: C
authors.lastname: Kondoh
authors.affiliation: Department of Clinical Oncology, Aichi Cancer Center Hospital, 1-1 Kanoko-den Chikusa-ku, Nagoya City, Aichi, Japan. kouheis0824@yahoo.co.jp.|Department of Gastroenterology and Gastrointestinal Oncology, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa City, Chiba, Japan. kouheis0824@yahoo.co.jp.
authors.forename: Kohei
authors.initials: K
authors.lastname: Shitara
authors.affiliation: Department of Clinical Oncology, Aichi Cancer Center Hospital, 1-1 Kanoko-den Chikusa-ku, Nagoya City, Aichi, Japan. mnomura@aichi-cc.jp.
authors.forename: Motoo
authors.initials: M
authors.lastname: Nomura
authors.affiliation: Department of Clinical Oncology, Aichi Cancer Center Hospital, 1-1 Kanoko-den Chikusa-ku, Nagoya City, Aichi, Japan. dtakahari@aichi-cc.jp.
authors.forename: Daisuke
authors.initials: D
authors.lastname: Takahari
authors.affiliation: Department of Clinical Oncology, Aichi Cancer Center Hospital, 1-1 Kanoko-den Chikusa-ku, Nagoya City, Aichi, Japan. tura@aichi-cc.jp.
authors.forename: Takashi
authors.initials: T
authors.lastname: Ura
authors.affiliation: Department of Radiation Oncology, Aichi Cancer Center Hospital, 1-1 Kanoko-den Chikusa-ku, Nagoya City, Aichi, Japan. tchbn@aichi-cc.jp.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Tachibana
authors.affiliation: Department of Radiation Oncology, Aichi Cancer Center Hospital, 1-1 Kanoko-den Chikusa-ku, Nagoya City, Aichi, Japan. ntomita@aichi-cc.jp.
authors.forename: Natsuo
authors.initials: N
authors.lastname: Tomita
authors.affiliation: Department of Radiation Oncology, Aichi Cancer Center Hospital, 1-1 Kanoko-den Chikusa-ku, Nagoya City, Aichi, Japan. 109103@aichi-cc.jp.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Kodaira
authors.affiliation: Department of Clinical Oncology, Aichi Cancer Center Hospital, 1-1 Kanoko-den Chikusa-ku, Nagoya City, Aichi, Japan. kmuro@aichi-cc.jp.
authors.forename: Kei
authors.initials: K
authors.lastname: Muro
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology* / Q000532:radiotherapy*; D006454:Hemoglobins; D006801:Humans; D008297:Male; D008875:Middle Aged; D010166:Palliative Care / Q000379:methods*; D011788:Quality of Life; D011879:Radiotherapy Dosage; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013274:Stomach Neoplasms / Q000150:complications* / Q000628:therapy
chemical_list: D006454:Hemoglobins