Gastric Cancer Bleeding Research Articles

Who should receive single-fraction palliative radiotherapy for gastric cancer bleeding?: An exploratory analysis of a multicenter prospective observational study (JROSG 17-3).

Although the Palliative Prognostic Index (PPI) has been used to predict survival in various cancers, to our knowledge, no study has examined its applicability in gastric cancer. This study aimed to determine the baseline PPI cutoff value for recommending single-fraction radiotherapy in patients with bleeding gastric cancer. This was a secondary analysis of the Japanese Radiation Oncology Study Group (JROSG) 17-3, a multicenter prospective study of palliative radiotherapy for bleeding gastric cancer. Discrimination was evaluated using a time-dependent receiver operating characteristic curve, and the optimal cutoff value was determined using the Youden index. A calibration plot was used to assess the agreement between predicted and observed survival. We enrolled 55 patients in JROSG 17-3. The respective median survival times were 6.7, 2.8, and 1.0months (p=0.021) for patients with baseline PPI scores of≤2, 2<PPI≤4, and PPI>4. The areas under the curve for predicting death within 2, 3, 4, and 5months were 0.813, 0.787, 0.775, and 0.721, respectively. The negative predictive value was highest when survival<2months was predicted and the Youden index was highest when the cutoff PPI value was 2. The calibration curve showed a reasonable agreement between the predicted and observed survival. Baseline PPI is useful for estimating short-term prognosis in patients treated with palliative radiotherapy for gastric cancer bleeding. A cutoff PPI value of 2 for estimating survival≤2months should be used to recommend single-fraction radiotherapy.

S2576 Application of Hemospray for Metastatic Bleeding Gastric Adenocarcinoma: A Case Report

Introduction: TC-325 hemostatic powder (Hemospray) is a mineral-based topical agent that acts as a mechanical barrier over a bleeding site. It is a non-invasive, safe, and effective modality in controlling active GI bleeding, with immediate response. Here, we present a case of bleeding metastatic gastric adenocarcinoma managed with Hemospray after the failure of standard endoscopic therapy. Case Description/Methods: A 64-year-old male presented to the emergency room (ER) for symptomatic anemia. His hemoglobin was 4.6 g/dL. CT imaging showed gastric cardia lesion with multiple hepatic metastases. After blood transfusion, EGD (Figure 1a) showed a cardia lesion with oozing blood from multiple sites. Endoscopic ultrasound with fine-needle aspiration, showing atypical cells. The patient continued to have melena requiring transfusions. CT angiogram was negative. Partial gastrectomy was not performed due to peritoneal carcinomatosis. Endoscopic hemostasis with epinephrine and clips failed (Figure 1b). Hemospray was deployed (Figure 1c) with an immediate response. Later patient underwent left gastric artery embolization (Figure 1d), liver biopsy and peritoneal node sampling that suggested metastatic adenocarcinoma with primary gastric malignancy. The patient and his family opted for palliative care and was discharged. Discussion: Gastric cancer accounts for 2-8% of overall UGIB and 58% bleeding risk compared to other GI malignancies. There are no specific guidelines and only limited evidence was available on managing malignancy-related UGIB. Nonresponsive, inoperable metastatic gastric cancer bleeding is challenging and extremely difficult to manage using conventional hemostasis techniques. Based on our case, we recommend utilizing Hemospray as a first-line, monotherapy or in combination to control bleeding until a definitive treatment, reducing morbidity and mortality.Figure 1.: (A) Submucosal gastric fundal mass distal to gastroesophageal junction with blood oozing from multiple sites (arrows), (B) Image showing endoscopic hemostatic clips placement (arrowheads), (C) Application of Hemospray over the Gastric Mass after unsuccessful attempts using standard-of-care hemostatic methods, (D) Showing embolization of the left gastroepiploic artery.

Palliative radiotherapy for gastric cancer bleeding: a multi-institutional retrospective study

BackgroundPalliative radiotherapy for gastric cancer bleeding has been reported to be a safe and effective treatment, but predictive factors for achievement of hemostasis and overall survival have not been established.MethodsIn this retrospective study, 120 courses of palliative radiotherapy for gastric cancer bleeding in 117 patients in 4 institutes in Japan were reviewed with approval of the ethical committee in each institute. The rate of achieving hemostasis was evaluated by 50% or more reduction of red blood cell transfusion before and after the start of radiotherapy, elevation of blood hemoglobin concentration in a period of 4 weeks from the start of radiotherapy or improvement of subjective or objective clinical symptoms in a period of 4 weeks from the start of radiotherapy. Predictive factors for overall survival and achieving hemostasis were investigated with the Cox hazards model.ResultsThe median overall survival period was 3.7 months. Multivariate analysis showed that absence of metastatic disease, higher biological effective dose, higher serum albumin level, lower blood urea nitrogen level and lower neutrophil-to-lymphocyte ratio (NLR) were associated with longer overall survival. Elevation of hemoglobin concentration in a period of 4 weeks from the start of radiotherapy (mean concentration: 8.2 g/dL vs. 8.9 g/dL, p = 0.006) and decrease in the amount of red cell transfusion from a 4-week period before to a 4-week period after the start of radiotherapy (mean amount: 716 mL vs. 230 mL, p < 0.0001) were observed. The overall rate of achievement of hemostasis was 59.6%. In multivariate analysis, higher biological effective dose was associated with achievement of hemostasis. Grade 2 or higher acute adverse effects related to radiotherapy were observed in 17.5% of cases in 120 treatment courses. Six cases (5.0%) had grade 3 or 4 adverse effects including gastric penetration in 1 patient and anorexia requiring total parental nutrition in 3 patients. No grade 5 adverse effects were observed.ConclusionsPalliative radiotherapy for gastric cancer bleeding seems to be an effective and safe treatment strategy. Higher treatment dose was associated with longer overall survival and a hemostatic effect. Some hematological parameters may predict overall survival, and they would be helpful for deciding the treatment strategy.

P-269 Advanced gastric cancer bleeding: Association of hemostatic radiotherapy and iron supplementation - Is there a survival benefit?

Tumor-related gastric hemorrhage is a major complication in advanced cancer stages and is associated with decreased quality of life, diminished survival, and prolonged hospitalizations. The aim of this study was to assess the efficacy of hemostatic radiotherapy (RT) in patients with tumor-related gastric bleeding and to evaluate the possible role of iron supplementation in this setting.

Verification of the Utility of Palliative Radiotherapy for Hemostasis of Gastric Cancer Bleeding: a Case Control Study.

Bleeding from unresectable gastric cancer is a localized condition that adversely affects quality of life. Radiotherapy can be used to treat gastric cancer bleeding when surgery, endoscopic treatment, and intravascular embolization are ineffective. This study evaluated the utility of radiotherapy for unresectable hemorrhagic gastric cancer. We retrospectively analyzed data from 33 patients with gastric cancer bleeding who underwent palliative radiotherapy in our hospital between April 2013 and May 2020. In this study, successful hemostasis was defined as >1month after starting radiotherapy with the patient alive and showing no need for blood transfusion, no drop in hemoglobin, and no evidence of melena or hematemesis. Patients comprised 26 men (79%) and 7 women (21%), with a median age of 71years (range, 41-78years). Hemostasis was achieved in 24 patients (73%). Thirty-two patients (94%) have been discharged home or transferred to the hospice. Patients with successful hemostasis from radiotherapy showed significantly longer overall survival than patients with unsuccessful hemostasis (p=0.0026). No toxicities of grade 2 or more were encountered. This retrospective study found that palliative radiotherapy for gastric cancer bleeding was useful and safe and can improve remaining quality of life in patients with poor prognosis.

Transcatheter arterial embolization for advanced gastric cancer bleeding: A single-center experience with 58 patients.

To investigate computed tomography and angiography findings and clinical outcomes after transcatheter arterial embolization for acute upper gastrointestinal bleeding from advanced gastric cancers.From January 2005 to December 2014, 58 patients with pathologically proven gastric cancer were treated at our institution with transcatheter arterial embolization due to acute upper gastrointestinal bleeding recalcitrant to endoscopic treatment. The electronic medical records for each patient were reviewed for clinical presentation, endoscopy history, computed tomography and angiographic findings, blood transfusion requirements, and follow-up results.Angiography findings were positive in 13 patients (22.4%): contrast extravasation was found in 9 patients and pseudoaneurysm in 4 patients. All patients with positive angiograms underwent selective embolization treatment. Those with negative angiography findings underwent empirical embolization. Gelfoam, n-butyl cyanoacrylate, coils, or a combination of these were used as embolic agents. The overall clinical success rate was 72.4% (42/58), and the success rate for patients with positive angiography was 53.8% (7/13). The median survival was 97.5 days (range, 7–1415 days), and the 1-month survival rate was 89.6% (52/58). The 1-month survival rate of the clinical success group was 95.2% (40/42), which was significantly higher than that of the clinical failure group (P = .04). The clinical success group also required significantly fewer transfusions (2.43 units, range 0–24 units) (P = .02).Transcatheter arterial embolization is a highly effective treatment for advanced gastric cancer with active bleeding. It should be considered as an additional treatment, especially when endoscopic or surgical treatment fails or when these approaches are difficult.

Clinical Outcomes in Patients with Gastric Adenocarcinoma Presenting with Upper Gastrointestinal Bleeding Initially

Introduction: Gastric adenocarcinoma presenting with upper gastrointestinal bleeding (UGIB) is uncommon and occurs in the late course of the disease. However, it is uncertain whether this bleeding predicts poor prognosis. Here, we aimed to evaluate the clinical outcomes of patients with gastric adenocarcinoma who initially presented with UGIB Methods: A total of 1,371 patients who were admitted with gastric adenocarcinoma were enrolled. Among them, a consecutive series of patients who were admitted with UGIB due to gastric adenocarcinoma as an initial presenting symptom were reviewed; of them, 44 patients were enrolled. Results: Twenty-four patients with cancer bleeding underwent curative gastrectomy, whereas 1,005 patients without cancer bleeding underwent curative gastrectomy (54.5% vs. 75.7%, P < 0.01). A male dominant pattern was typical in cancer bleeding patients (P < 0.01). Most patients (75.0%) had spontaneous resolution of bleeding, and the rate of successful therapeutic intervention was 91%. There was a significant difference in the rate of non-curative resection and palliative bypass surgery due to upgraded stage between the patients with gastric cancer bleeding and without bleeding (P < 0.01). Among the patients having curative resection, there was no statistical difference in disease-free survival the patients with gastric cancer bleeding and without bleeding (P = 0.31). Conclusion: In patients with UGIB caused by gastric adenocarcinoma as an initial presentation, the probability of curative resection was significantly low. When patients with gastric adenocarcinoma initially present with UGIB, the cancer stage can be underestimated; thus, a careful staging work-up should be needed.563_A Figure 1. Therapies for bleeding included hemoclipping (n = 9) (Figure 1A), electrocoagulation (n = 5) (Figure 1B), epinephrine injection (n = 1), angiographic embolization (n = 1) (Figure 1C)563_B Figure 2. There was no difference in DFS or progression-free survival in patients who underwent curative resection (n = 24) compared with age- and sexmatched controls (P = 0.31) (Figure 2)

Can Endoscopic Bleeding Control Improve the Prognosis of Advanced Gastric Cancer Patients?: A Retrospective Case-Control Study.

Gastric bleeding is not rare and difficult to treat in gastric cancer patients. We investigated whether this affects survival and if successful bleeding control improves the prognosis. We retrospectively reviewed medical records for 64 subjects who underwent endoscopic therapy for gastric cancer bleeding at Asan Medical Center from January 2012 to December 2014 (bleeding group). Each subject was matched 1:2 by age, sex, and American Joint Committee on Cancer staging with 128 randomly selected patients treated for stomach cancer during the same period (control group). Median survival, bleeding treatment methods, successful bleeding control, and rebleeding rate were investigated. The median age was 58.5 years, the male to female ratio 4.3:1. The initial hemostasis rate was 73.4%. Most patients were treated with a single method (37 patients, 57.8%); the coagrasper (32/95 cases, 33.7%) was the most frequently used treatment. Among the 47 patients in which successful bleeding control was achieved, 17 (36.2%) experienced rebleeding after 3 days. The median survival was longer in the control than in the bleeding group (18.5 vs. 6.5 mo), and in the successful bleeding control than in the failed bleeding control group (8.5 vs. 1.8 mo). However, the successful bleeding control group had lower survival than the control group (18.5 vs. 8.5 mo). Multivariate analysis showed that the risk of bleeding was lower in Borrmann type II, IV cancer, but was higher in the patients using antiplatelet or anticoagulant. Successful bleeding control is essential for improving survival in bleeding gastric cancer patients.

Tu1363 Effect of Proton Pump Inhibitor on Prevention of Gastric Cancer Bleeding: A Randomized Controlled Trial

Tu1363 Effect of Proton Pump Inhibitor on Prevention of Gastric Cancer Bleeding: A Randomized Controlled Trial

P-063 Clinical outcomes in patients with gastric cancer bleeding as initial presenting symptom

P-063 Clinical outcomes in patients with gastric cancer bleeding as initial presenting symptom

Primary Squamous Cell Carcinoma of the Stomach: Two Case Reports and a Literature Review

Primary squamous cell carcinoma (SCC) of the stomach is rare. In this paper, the patient in Case 1 is a 57-yearold man who underwent partial gastrectomy and adjuvant chemotherapy for primary SCC of the stomach. He survives more than 4 years as of the writing of this report. The patient in Case 2 is a 49-year-old man who was also diagnosed as primary SCC of the stomach. He died of massive gastric cancer bleeding 2 months after the diagnosis. This report is followed by a literature review and further discussion of diagnostic criteria and palliative gastrectomy in these patients.

Outcome of endoscopic therapy for cancer bleeding in patients with unresectable gastric cancer

Gastric cancer bleeding is not rare complication in patients with advanced gastric cancer (AGC). The aim of this study was to evaluate the efficacy and clinical outcomes of endoscopic therapy (ET) for upper gastrointestinal bleeding (UGIB) from unresectable AGC. Data from 113 patients with UGIB from unresectable AGC who underwent ET at the National Cancer Center, Korea were analyzed retrospectively. Success rates of endoscopic hemostasis, rebleeding rates, mortality at 30 days, and overall survival (OS) rate after initial hemostasis were investigated. The initial hemostasis rate was 92.9% (105/113). Electrocoagulation was the most common method used (92.0%, 104/113), and combination ET was required in 34 patients (30.1%). Rebleeding occurred in 43 patients (41.0%); 3-day and 30-day rebleeding rates were 18.1% and 29.5%, respectively. Multivariate logistic regression analysis showed that transfusion of packed red blood cells (> 5 units) was associated with early rebleeding (≤ 3 days after initial hemostasis) (odd ratio, 4.75; 95% confidential interval, 1.45-15.57; P = 0.010). ET was attempted in 18 patients with rebleeding; hemostasis was achieved in 88.9%. The 30-day mortality rate after initial bleeding event was 15.9%. Median OS after initial hemostasis was 3.2 months. OS was lower for patients with early rebleeding than for those with late rebleeding (> 3 days after initial hemostasis) or without rebleeding (1.0, 3.1, and 4.3 months, respectively; P = 0.004). ET, primarily endoscopic electrocoagulation, achieved a high initial hemostasis rate for UGIB in patients with unresectable AGC. However, rebleeding frequently occurred, and early rebleeding was associated with poor survival.

Use of Antithrombin and Thrombomodulin in the Management of Disseminated Intravascular Coagulation in Patients with Acute Cholangitis

Background/AimsTo evaluate the usefulness and safety of treating disseminated intravascular coagulation (DIC) complicating cholangitis primarily with antithrombin (AT) and thrombomodulin (rTM).MethodsA DIC treatment algorithm was determined on the basis of plasma AT III levels at the time of DIC diagnosis and DIC score changes on treatment day 3. Laboratory data and DIC scores were assessed prospectively at 2-day intervals.ResultsDIC reversal rates >75% were attained on day 7. In the DIC reversal group, statistically significant differences from baseline were observed in interleukin-6 and C-reactive protein levels within 5 days. Patients with no DIC score improvements after treatment with AT alone experienced slow improvement on a subsequent combination therapy with rTM. Although a subgroup with biliary drainage showed greater improvement in DIC scores than did the nondrainage subgroup, the mean DIC score showed improvement even in the nondrainage subgroup alone. Gastric cancer bleeding that was treated conservatively occurred in one patient. As for day 28 outcomes, three patients died from concurrent malignancies.ConclusionsAlthough this algorithm was found to be useful and safe for DIC patients with cholangitis, it may be better to administer rTM and AT simultaneously from day 1 if the plasma AT III level is less than 70%.

Radiation Therapy for Gastric Cancer Bleeding

To evaluate the outcome of palliative radiotherapy (RT) for patients with gastric cancer bleeding. A retrospective review of 30 patients with gastric cancer bleeding who underwent palliative RT was conducted. Twenty-three patients who received a dose of > or = 30 Gy in 10 fractions were eligible. The palliative effect was evaluated both in a subjective and objective manner. Subjective symptomatic relief of bleeding was determined and an objective response was evaluated by identifying the amount of transfused packed red blood cells (PRBC) and the mean hemoglobin (Hb) level of patients before and after RT. Subjective symptom relief was observed in 21 patients. The number of transfused PRBC units was 2 to 25 (median, 6) during the month before RT and 0 to 16 (median, 0) during the month after RT (P < 0.001). The average level of Hb increased from 9.1 +/- 1.6 g/dL to 10.6 +/- 1.6 g/dL (P < 0.001). In 9 patients whose laboratory findings were available for > or = 3 months after RT, the mean Hb at one, two, and three months after RT was 10.7 +/- 1.7 g/dL (P = 0.004), 10.5 +/- 1.0 g/dL (P = 0.039), and 9.9 +/- 1.0 g/dL (P = 0.164), respectively. The median number of transfused PRBC units decreased from 6 to 0 during the three months after RT. RT may be an effective treatment for gastric cancer bleeding when other modalities are not feasible. In this study, 91% of the patients experienced symptomatic palliation with an elevated Hb level and a decreased number of transfusions after RT.

Palliative radiation therapy for hemorrhage of unresectable gastric cancer: a single institute experience

To clarify the toxicity of palliative radiotherapy (RT) and its efficacy against bleeding of unresectable gastric cancer. Clinical data of 19 patients received palliative RT for bleeding from unresectable gastric cancer were reviewed. The median total dose and dose per fraction were 40 Gy (range 2-50 Gy) and 2.5 Gy (range 1.8-3 Gy). The treatment success rate was 68.4%. By using a tumor alpha/beta ratio of 10, biological effective dose of 50 Gy(10) or more was significantly correlated with treatment success (P = 0.040). The median event-free survival was 1.5 months after RT and the median overall survival from starting RT was 3.4 months. Grade 3 nausea and anorexia were recorded in 1 and 3 patients, respectively. Palliative RT was effective for hemostasis in patients with gastric cancer bleeding with minor adverse events.