Main Session
Sep
28
PQA 04 - Breast Cancer, Patient Reported Outcomes/QoL/Survivorship, Functional Radiation Medicine, Hematologic Malignancies, Palliative Care, and International/Global Oncology
2821 - Hemostatic Palliative Radiotherapy for Bleeding Upper Gastrointestinal Tumors: A Retrospective Study
Presenter(s)
Kenta Nimura, MD - Aichi Cancer Center Hospital, Nagoya, Aichi
K. Nimura, Y. Koide, M. Noguchi, S. Hashimoto, H. Tachibana, and T. Kodaira; Aichi Cancer Center, Nagoya, Japan
Purpose/Objective(s):
We aimed to evaluate the hemostatic response to palliative radiotherapy for bleeding upper gastrointestinal (UGI) tumors, including the impact of an individualized hemostatic criteria in patients who resume systemic therapy.Materials/Methods:
We retrospectively analyzed patients who received palliative radiotherapy for bleeding UGI tumors from September 2014 to June 2025. Hemostatic response Criterion A was defined as (1) no transfusion for 1 week and (2) no additional interventions with serum hemoglobin (Hb) > 8.0 g/dL at 2 and 4 weeks after radiotherapy. Patients who did not achieve Hb > 8.0 g/dL but were able to continue systemic therapy without transfusion were considered responders under Criterion B.Results:
Ninety patients were included (22 women, 24%). ECOG performance status was 0/1/2/3/4 in 0/45/33/10/2 patients. Median age was 69 years (IQR 60–77). Primary tumors included stomach (n=65), pancreas (n=15), gastroesophageal junction (n=4), and others (n=6). Radiotherapy schedules most commonly included 8 Gy single fraction (n=16), 20 Gy in 5 fractions (n=43), and 30 Gy in 10 fractions (n=26); two patients did not complete treatment. After radiotherapy, 45 patients (50%) initiated or resumed systemic therapy at a median of 15 days (range 0–65; IQR 11–20). The median survival follow-up was 27.5 months (95% CI, 26.2–not assessable), during which 74 patients (82%) died. Median overall survival was 3.9 months (95% CI, 2.9–5.3). Hemostasis was evaluable in 83 patients (92%) at 2 weeks and 68 patients (76%) at 4 weeks. Hemostatic response was achieved in 51/90 patients (57%; Criteria A/B = 47/4) at 2 weeks and 53/90 patients (59%; Criteria A/B = 49/4) at 4 weeks. Overall, 61/90 patients (68%) achieved hemostasis at least once, with a median time to hemostasis of 14 days (IQR 12–20). Among these 61 responders, rebleeding occurred in 29 patients (48%) at a median of 115 days (IQR 63–226) after hemostasis. Four patients received salvage treatment (re-irradiation in 2; transcatheter arterial embolization in 2), while the remaining 26 were managed with supportive care. No grade =3 adverse events related to radiotherapy were observed.Conclusion:
Palliative radiotherapy provides hemostatic benefit for bleeding UGI tumors without severe toxicities, with half of patients resuming systemic therapy. Based on these findings, a prospective study is ongoing (STOP-BLEED; UMIN000059406), incorporating hemostatic criteria that consider the feasibility of continuing systemic therapy after treatment.