Palliative radiotherapy for bleeding control in patients with unresectable gastric cancer

Introduction: Gastric cancer is a significant global health concern, frequently diagnosed at an advanced, unresectable stage. This often leads to severe symptoms, such as bleeding, pain, and malnutrition, which greatly affect patients' quality of life. Tumor-induced bleeding is a particularly critical issue requiring urgent intervention. While palliative treatments like surgery, endoscopy, and arterial embolization are available, radiotherapy (RT) has become an important non-invasive option for controlling bleeding, especially when other treatments are not viable.

Materials and Methods: This retrospective study reviewed medical records of patients with unresectable advanced gastric cancer who received palliative RT for bleeding control between January 2012 and December 2021 at University Hassan II Hospital. Patients were included if they had a histologically confirmed diagnosis of gastric cancer and confirmed tumor bleeding. Successful hemostasis was defined as survival for at least one month without further bleeding or transfusions. Survival outcomes were analyzed using Kaplan-Meier methods.

Results: The study included 23 patients, with a median age of 59.21 years. Radiation doses ranged from 6.5 to 45 Gy, with a median dose of 32 Gy. Hemostasis was successfully achieved in 86.95% of patients, with a significant increase in hemoglobin levels from a baseline of 7.15 g/dL to 10.72 g/dL post-treatment (p=0.0001). However, two patients experienced re-bleeding during the follow-up period, with a median time to recurrence of 3.3 months. The median overall survival was 15.44 months. Radiation therapy was generally well-tolerated, with mild side effects such as grade 1 anorexia and nausea.

Conclusion: Palliative RT is an effective, well-tolerated treatment for bleeding control in patients with unresectable advanced gastric cancer, providing significant clinical benefits and prolonging survival in certain cases. Further research is necessary to refine radiotherapy strategies for this patient population.