Short-course palliative radiation therapy leads to excellent bleeding control: A single centre retrospective study

Lucas Gomes Sapienza; Matthew Stephen Ning; Anuja Jhingran; Lilie L Lin; Caio Raposo Leão; Bruna Bueno da Silva; Antônio Cássio de Assis Pellizzon; Maria José Leite Gomes; Glauco Baiocchi

doi:10.1016/j.ctro.2018.11.007

Short-course palliative radiation therapy leads to excellent bleeding control: A single centre retrospective study

Clin Transl Radiat Oncol. 2018 Nov 22:14:40-46. doi: 10.1016/j.ctro.2018.11.007. eCollection 2019 Jan.

Authors

Lucas Gomes Sapienza^{1

2}, Matthew Stephen Ning³, Anuja Jhingran³, Lilie L Lin³, Caio Raposo Leão¹, Bruna Bueno da Silva¹, Antônio Cássio de Assis Pellizzon¹, Maria José Leite Gomes⁴, Glauco Baiocchi⁵

Affiliations

¹ Department of Radiation Oncology, A.C. Camargo Cancer Center, São Paulo, SP, Brazil.
² Department of Radiation Oncology, Hospital Central do Exército do Rio de Janeiro (HCE-RJ), Rio de Janeiro, RJ, Brazil.
³ Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
⁴ Department of Radiation Oncology, Hospital Federal dos Servidores do Estado (HFSE-RJ), Rio de Janeiro, RJ, Brazil.
⁵ Department of Gynecologic Oncology, A.C. Camargo Cancer Center, São Paulo, SP, Brazil.

Abstract

Purpose: To compare and evaluate the utility of varying hemostatic radiotherapy prescriptions for emergent palliation of bleeding tumors.

Materials and methods: This retrospective study analyzed 112 consecutive patients treated with radiotherapy for emergent palliation of bleeding tumors at an academic institution. Study endpoints included: primary bleeding control; re-bleeding rate after initial control; treatment interruption rate; overall survival; and death within 30 days of treatment.

Results: The most commonly prescribed fractionations were: 20 Gy in 5 fractions, 30 Gy in 10 fractions, and 8 Gy in a single fraction. The overall primary bleeding control rate was 89%. By location, primary bleeding control rates were 89% (31/35), 80% (16/20), 88% (14/16), 93% (13/14), 100% (9/9), and 100% (6/6) for gastrointestinal, genitourinary, head and neck, thoracic, extremity, and gynecologic sites, respectively. The overall re-bleeding rate following initial bleeding control was 25%. Female patients had a significantly reduced risk of bleeding recurrence (HR 0.18 [0.04-0.79], p = 0.02). Longer fractionation regimens (>5 fractions) were not associated with a reduced incidence of re-bleeding (p = 0.65), but were associated with more treatment interruptions (p = 0.02). The 1-year overall survival rate in this population was 24%, with mortality greater in patients with poor performance status (HR 2.99 [1.36-6.58], p = 0.007).

Conclusions: Regardless of prescription, palliative radiotherapy is highly effective for primary bleeding control, with both long and short regimens demonstrating equal hemostatic effect and durability in the emergent setting. Longer radiotherapy regimens (>5 fractions), however, are accompanied by increased treatment interruptions and hospital days. Therefore, shorter hemostatic regimens (<5 fractions) are preferable in this palliative setting, with respect to minimizing treatment burden for patients while achieving symptomatic relief.

Keywords: Bleeding control; Fractionation; Hemostatic radiotherapy; Palliative radiotherapy; Treatment interruption.