3508 - Inpatient Radiotherapy: Insights for Hemostasis Consults

Purpose/Objective(s): In late 2022, our center launched an inpatient radiation oncology consultation service due to high demand for radiotherapy (RT) in hospitalized patients. Over 1572 consults have been completed in 24 months, addressing emergent needs to care coordination. This analysis focuses on RT for hemostasis, a palliative intervention with varying doses based on tumor site and patient stability. Persistent bleeding poses a significant quality of life detriment, often requiring multiple transfusions/hospitalizations. RT achieves hemostasis acutely through tumor swelling and sub-acutely via fibrosis of blood vessels. We hypothesize rapid RT initiation may shorten hospital stays.

Materials/Methods: A retrospective chart review was conducted on inpatient consults from December 2022 to November 2024. Of 132 consults for "bleeding", 6 were duplicates or canceled leaving 126 analyzed. Variables assessed: gender, histology, bleeding symptoms, RT prescriptions, hemoglobin (Hgb) levels, and consult-to-Tx timelines. Univariate analyses used t-tests and chi-square.

Results: RT was recommended in 83 of 126 cases (65.9%), with 74 proceeding to simulation (62 inpatient, 12 outpatient). RT was not advised in 43 cases (34.1%) due to alternative treatment options (ie surgery, IR, endoscopy), prior RT, or lack of a targetable lesion. Disease sites and symptoms are summarized in table 1. Among those simulated, 65 (87.8%) completed RT. Reasons for not completing RT included hospice discharge (n=5), death due to hemorrhage during Tx (n=3), and inability to tolerate simulation (n=1). Doses ranged from 8Gy-40Gy/1-20Fx. Tx was considered effective if there were no additional transfusions once RT started or Hgb was increasing or stable by 48hrs post treatment. Of 58 patients with sufficient Hgb data (pre, 2 days post-Tx, and 2 weeks post-Tx), 48 (64.9% of simulated patients) met criteria for effective Tx. On sub-analysis by RT dose, Tx effect was observed in 10/12 cases receiving 8Gy/1Fx, 5/7 receiving 30Gy/10Fx, and 5/5 receiving 12Gy/3Fx. Among 62 inpatient cases (RT initiated pre-discharge), median time from admission to consult was 1 day (range 0-21) and time from consult to RT initiation was 1 day (range 0-9). RT was completed before discharge in 40 cases (64.5%), with a median 2-day interval from RT completion to discharge. In the remaining 22 cases, RT was completed a median of 8 days post-discharge. No significant correlation between RT initiation and discharge time (p=0.98).

Conclusion: Data confirm (a) many emergent inpatient radiation consults are unsuitable for RT, as seen in 43 untreated cases and 3 deaths during Tx, and (b) RT provides hemostasis in carefully selected patients. Significant variability in dose and fractionation was noted among radiation oncologists. These findings support ongoing efforts to optimize the consultation and Tx process at our center.