2766 - Outcomes in Hospitalized Patients Evaluated for Palliative Radiation Therapy for Tumor-Related Bleeding
Presenter(s)
S. T. Jones1, C. White2, Z. Zhang3, M. E. Freret4, V. S. Brennan5, M. Zhang6, K. Lapen1, A. J. Xu5, and D. Yerramilli5; 1Memorial Sloan Kettering Cancer Center, New York, NY, 2Memorial Sloan-Kettering Cancer Center, New York, NY, 3Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, 4Department of Radiation Oncology, Sylvester Comprehensive Cancer Center, University of Miami Leonard M. Miller School of Medicine, Miami, FL, 5Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, 6MSKCC, New York, NY
Purpose/Objective(s): Tumor-related bleeding is a common and potentially life-threatening complication in advanced malignancy, for which radiation therapy (RT) is frequently used. Predictors of survival and hemostatic response remain poorly defined. We evaluated hospitalized patients with tumor-related bleeding for whom the inpatient radiation oncology service was consulted to identify factors associated with overall survival (OS), post-RT transfusion burden, and time to bleeding control.
Materials/Methods: We retrospectively analyzed hospitalized patients with tumor-related bleeding. OS was defined from 14 days after first bleed using a landmark approach to reduce immortal time bias. Transfusion burden was defined as total transfusion units within 28 days after RT; pre-consult transfusions included all units from first bleed to consultation. Transfusions for non-bleeding indications were excluded. Time to bleeding control was measured from RT initiation to documented improvement. The Kaplan–Meier method and Cox models were used to evaluate OS and bleeding control, whereas Poisson regression assessed transfusion burden.
Results: Among 466 consulted patients, 320 (68.7%) received RT, of whom 183 (57.2%) received RT within 14 days of first bleed. The most common RT regimens were 20 Gy in 5 fractions (36.8%) and 14.8 Gy in 4 fractions (20.8%), followed by 30 Gy in 10 fractions (7.9%), 8 Gy in 1 fraction (7.2%), and 30 Gy in 5 fractions (4.7%). GU/Gyn malignancies demonstrated improved OS compared with GI tumors (HR 0.73, p=0.039), and higher performance status (KPS) was associated with improved OS (HR 0.98, p<0.001). Greater baseline bleeding severity predicted increased post-RT transfusion burden (IRR 1.12, p<0.001), while higher baseline hemoglobin was protective (IRR 0.80, p=0.001). Sarcoma histology was associated with increased transfusion requirements (IRR 2.03, p=0.020) and slower bleeding control (HR 0.36, p<0.001).
Conclusion: Tumor histology and performance status were independently associated with survival, with GU/Gyn malignancies demonstrating improved outcomes. Greater baseline bleeding severity was correlated with higher post-RT transfusion burden. Sarcoma histology was associated with increased transfusion requirements and slower bleeding control, suggesting relative treatment resistance and the need for tailored management.