Clinical outcomes of palliative 3-dimensional conformal external beam gastric radiotherapy: single center experience

Abstract

Aim: Patients diagnosed with locally advanced and/or metastatic gastric cancer and who cannot undergo surgery may need palliative treatment during their follow-up. There is scarce data about outcomes of palliative gastric radiotherapy (RT). In this study, we aimed to investigate the effect of 3-D external beam RT on oncological outcomes, as a non-invasive method.
Material and Method: From 2013 to 2017, sixteen gastric cancer patients treated with palliative external RT in our institutional clinic were evaluated. Only patients who received palliative gastric radiotherapy for obstruction, pain and bleeding were analyzed, and patients who had previously received RT to the abdomen or who were given RT for adjuvant purposes were not included in the analysis.
Results: Seven patients (43%) were not able to finish the planned palliative course. Thirty Gray with 10 fractions was the most planned RT schedule. Almost half of the patients (%56) received chemotherapy before RT. Overall survival was found to be median 2 months. Median survival was better in patients who were able to receive 28 Gy bioequivalent dose (4 vs 0.3 months, p≤0.00). Purpose of palliation also found to be a significant factor on survival. Patients who were referred for pain have found to be better survival rather than bleeding and obstruction (13 vs 0.7 months, p=0.03).
Conclusion: External radiotherapy is an easily applicable and effective method for palliation in gastric cancer patients. Early referral for radiotherapy in patients who need palliation may increase oncological outcomes. It has been observed that the prognosis is worse in patients who received palliative radiotherapy due to gastric bleeding and obstruction.

Keywords

• Gastric Cancer
• Radiotherapy
• Gastrointestinal Hemorrhage

Üç boyutlu konformal palyatif mide radyoterapisi uygulanan hastalarda klinik sonuçlar: tek merkez deneyimi

Abstract

Giriş: Lokal ileri ve/veya metastatik mide kanseri teşhisi konulan ve ameliyat edilemeyen hastaların takipleri sırasında palyatif tedaviye ihtiyaç duyulabilir. Bu çalışmada non-invaziv bir yöntem olarak palyatif eksternal 3-D mide radyoterapisinin, onkolojik sonuçlara etkisini araştırmak amaçlanmıştır Gereç ve Yöntem 2013-2017 yılları arasında kliniğimizde palyatif eksternal radyoterapi (RT) ile tedavi edilen 16 mide kanseri hastası değerlendirildi. Yalnızca tıkanıklık, ağrı ve kanama nedeniyle palyatif mide radyoterapisi alan hastalar analize dahil edildi ve daha önce abdomen bölgesine RT uygulanan veya adjuvan amaçlı RT verilen hastalar analize dahil edilmedi. Bulgular Tüm hastalar incelendiğinde, 7 hastanın, (%43) planlanan palyatif radyoterapisini tamamlayamadığı bulundu. 10 fraksiyonlu 30 Gy palyatif şema, en çok planlanan RT programıydı ve hastaların yaklaşık yarısı (%56) RT öncesinde kemoterapi almıştı. Genel sağ kalım tüm kohortta medyan 2 ay olarak hesaplandı. Ortalama sağkalım 28 Gy biyoeşdeğer doz alabilen hastalarda daha iyiydi (4'e 0,3 ay, p≤0,00). Palyasyonun amacı da, sağkalıma etki eden bir faktör olarak bulundu. Ağrı nedeniyle RT uygulanan hastaların, kanama ve obstrüksiyon nedeniyle RT uygulananlardan daha iyi sağ kalıma sahip olduğu bulundu (13'e karşı 0.7 ay, p=0.03). Sonuç Eksternal 3-D radyoterapi, mide kanserli hastalarda palyasyon için kolay uygulanabilir ve etkili bir yöntemdir. Palyasyon ihtiyacı olan hastalarda radyoterapiye erken sevk edilmesi onkolojik sonuçları artırabilir. Mide kanaması ve tıkanıklığı nedenyile palyatif radyoterapi uygulanan hastalarda prognozun daha kötü seyrettiği gözlenmiştir.

Keywords

• Mide Kanseri
• Radyoterapi
• Gastrointestinal Kanama

References

1. Sung H, Ferlay J, Siegel RL, et al. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries CA: A Cancer Journal for Clinicians 2021; 71: 209-249.
2. Wanebo HJ, Kennedy BJ, Chmiel J, Steele G Jr, Winchester D, Osteen R. Cancer of the stomach. A patient care study by the American College of Surgeons. Ann Surg 1993; 218: 583-92.
3. Allum WH, Powell DJ, McConkey CC, Fielding JW. Gastric cancer: a 25-year review. British J Surg 1989; 76: 535-40.
4. Kim MM, Rana V, Janjan NA, et al. Clinical benefit of palliative radiation therapy in advanced gastric cancer. Acta Oncologica 2008; 47: 421–27.
5. Hashimoto K, Mayahara H, Takashima A, et al. Palliative radiation therapy for hemorrhage of unresectable gastric cancer: a single institute experience. J Cancer Res Clin Oncol 2009; 135: 1117-23.
6. Lee JA, Lim DH, Park W, Ahn YC, Huh SJ. Radiation therapy for gastric cancer bleeding. Tumori 2009; 95: 726–30.
7. Asakura H, Hashimoto T, Harada H, et al. Palliative radiotherapy for bleeding from advanced gastric cancer: is a schedule of 30 Gy in 10 fractions adequate? J Cancer Res Clin Oncol 2011; 137: 125–30
8. Chaw CL, Niblock PG, Chaw CS, Adamson DJ. The role of palliative radiotherapy for haemostasis in unresectable gastric cancer: a single-institution experience. Ecancermedicalscience 2014; 8: 384.

9. Tey J, Choo BA, Leong CN, et al. Clinical outcome of palliative radiotherapy for locally advanced symptomatic gastric cancer in the modern era. Medicine 2014; 93: e118.
10. Kondoh C, Shitara K, Nomura M, et al. Efficacy of palliative radiotherapy for gastric bleeding in patients with unresectable advanced gastric cancer: a retrospective cohort study. BMC Palliat Care 2015; 14: 37.
11. Takeda K, Sakayauchi T, Kubozono M, et al. Palliative radiotherapy for gastric cancer bleeding: a multi-institutional retrospective study. BMC Palliat Care 2022; 21: 52.
12. Mitsuhashi N, Ikeda H, Nemoto Y, Kuronuma M, Kamiga M, Hiroshima Y. Hemostatic effect of palliative radiation therapy in preventing blood transfusions from bleeding occurring within advanced gastric cancer. Palliat Med Rep 2021; 2: 355-64.
13. Kim YI, Choi IJ. Endoscopic management of tumor bleeding from inoperable gastric cancer. Clin Endosc 2015; 48: 121-7.
14. Kamarajah SK, Markar SR, Phillips AW, Salti GI, Dahdaleh F, Griffiths EA. Palliative gastrectomy for metastatic gastric adenocarcinoma: a national population-based cohort study. Surgery 2021; 170: 1702-10.
15. Manfredi S, Dior M, Bouche O, et al. Daily practices in chemotherapy for advanced gastric or gastroesophageal junction adenocarcinoma: METESTOMAC French prospective cohort. Cancer Med 2022; 10: 1002.
16. Halpern AL, McCarter MD. Palliative management of gastric and esophageal cancer. Surg Clin North Am 2019; 99: 555-69.
17. Lee YH, Lee JW, Jang HS. Palliative external beam radiotherapy for the treatment of tumor bleeding in inoperable advanced gastric cancer. BMC Cancer 2017; 17: 541.
18. Tey J, Soon YY, Koh WY et al. Palliative radiotherapy for gastric cancer: a systematic review and meta-analysis. Oncotarget 2017; 8: 25797-805
19. Inoue T. Successful palliative radiotherapy for malignant cardiac obstruction caused by gastric cancer. Cureus 2022; 14: e27466.
20. Cooper JS, Guo MD, Herskovic A, et al. Chemoradiotherapy of locally advanced esophageal cancer: long-term follow-up of a prospective randomized trial (RTOG 85-01). Radiation Therapy Oncology Group. JAMA 1999; 281: 1623-7.
21. Herskovic A, Martz K, al-Sarraf M, et al. Combined chemotherapy and radiotherapy compared with radiotherapy alone in patients with cancer of the esophagus. N Engl J Med 1992; 326: 1593-8.
22. Penniment MG, De Ieso PB, Harvey JA, et al. Palliative chemoradiotherapy versus radiotherapy alone for dysphagia in advanced oesophageal cancer: a multicentre randomised controlled trial (TROG 03.01). Lancet Gastroenterol Hepatol 2018; 3: 114-124.