Abstract
BackgroundTo assess the outcomes and prognostic factors associated with palliative external beam radiotherapy (EBRT), administered to patients with advanced gastric cancer.MethodsForty-two patients with bleeding gastric tumors that received EBRT for palliation were analyzed. The response to EBRT was assessed by the palliation of tumor bleeding. Patients were classified as either responders, or non-responders to EBRT. The prognostic utility of clinical and dosimetric variables was examined in a multivariate logistic regression model. The optimal dose cutoff to classify the two groups was determined with receiver operating characteristic analysis.ResultsThe palliation of gastric tumor bleeding after EBRT was achieved in 29 patients (69.0%). The time to resolve tumor bleeding ranged from 1 to 84 days (median, 15 days). The median duration of palliation was 14.9 weeks. The median EBRT dose was 40 Gy in responders vs. 21 Gy in non-responders, with the difference being significant (p < 0.001). The biologically effective dose (using α/β = 10, BED10) for responders was significantly higher than the BED10 for non-responders (median 48 Gy vs. 26.4 Gy, p < 0.001), and the optimal cut off value to separate the two groups was 36 Gy (p < 0.001). The absence of distant metastasis and the use of concurrent chemotherapy generally showed a better EBRT response (p = 0.079 and p = 0.079, respectively). In the multivariate analysis, BED10 ≥ 36 Gy was the most significant factor associated with EBRT response (p = 0.001). Overall survival (OS) and re-bleeding-free survival was median 12.6 weeks and 14.9 weeks. The responders to EBRT showed superior OS (16.6 vs. 5.1 months, p < 0.001). Neither acute nor chronic toxicities of grade 3 or higher were observed.ConclusionsEBRT is an effective method for treating tumor bleeding in advanced gastric cancer, and does not induce severe toxicity.
Highlights
To assess the outcomes and prognostic factors associated with palliative external beam radiotherapy (EBRT), administered to patients with advanced gastric cancer
Patients The current study retrospectively reviewed the medical data of 42 patients with gastric cancer who experienced tumor bleeding with or without obstruction caused by the tumor, with subsequent EBRT treatment with a palliative aim
Seven patients were treated with concurrent chemoradiotherapy, using a chemotherapy regimen consisting of 5-fluorouracil/leucovorin
Summary
To assess the outcomes and prognostic factors associated with palliative external beam radiotherapy (EBRT), administered to patients with advanced gastric cancer. The preferred treatment of gastric cancer for curative-intent is surgical resection. Several patients presenting with unresectable disease are treated with chemotherapy [3]. Despite advancements in the early detection and treatment of gastric cancer, the prognosis from curative treatment remains poor, and more than 50% of the patients will develop metastatic disease [3,4,5]. Palliative external beam radiotherapy (EBRT) may be a non-invasive, safe, and readily available procedure, with relatively few restrictions regarding the eligibility for treatment [11]. EBRT is an effective procedure for the immediate
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