Hemostatic radiotherapy in clinically significant tumor-related bleeding: excellent palliative results in a retrospective analysis of 77 patients

• Published in: Radiation oncology (London, England) Vol. 18; no. 1; p. 203
• Main Authors: Guhlich, Manuel, Maag, Teresa Esther, Dröge, Leif Hendrik, Hille, Andrea, Donath, Sandra, Bendrich, Stephanie, Schirmer, Markus Anton, Nauck, Friedemann, Leu, Martin, Riggert, Joachim, Gallwas, Julia, Rieken, Stefan
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 20.12.2023; BioMed Central; BMC
• Subjects: Acute toxicity; Bleeding; Blood; Cancer bleeding; Cancer therapies; Carcinoma; Care and treatment; Cervical carcinoma; Cervix; Clinical significance; Complications; Development and progression; Emergency radiation; Endometrium; Endoscopy; Female; Gastric cancer; Glycosylated hemoglobin; Gynecology; Health aspects; Health services; Hematuria; Hemoglobin; Hemoglobins; Hemorrhage - etiology; Hemorrhage - radiotherapy; Hemostatics; Humans; Measurement; Palliative Care - methods; Palliative therapy; Patient outcomes; Patients; Pilot projects; Radiation dosage; Radiation therapy; Radiotherapy; Radiotherapy Dosage; Regression models; Remission (Medicine); Retrospective Studies; Retrospective study; Software; Statistical analysis; Subgroups; Survival; Toxicity; Transfusion; Tumors; Germany; Palliative therapy; Retrospective study; Transfusion; Emergency radiation; Radiotherapy; Cancer bleeding
• ISSN: 1748-717X; 1748-717X
• DOI: 10.1186/s13014-023-02391-5

Significant bleeding of tumor sites is a dreaded complication in oncological diseases and often results in clinical emergencies. Besides basic local and interventional procedures, an urgent radiotherapeutic approach can either achieve a bleeding reduction or a bleeding stop in a vast majority of patients. In spite of being used regularly in clinical practice, data reporting results to this therapy approach is still scarce. We retrospectively analyzed 77 patients treated for significant tumor-related bleeding at our clinic between 2000 and 2021, evaluating treatment response rate, hemoglobin levels, hemoglobin transfusion necessity, administered radiotherapy dose and overall survival. Response rate in terms of bleeding stop was 88.3% (68/77) in all patients and 95.2% (60/63) in the subgroup, wherein radiotherapy (RT) was completed as intended. Hemoglobin transfusions decreased during treatment in a further subgroup analysis. Median overall survival (OS) was 3.3 months. Patients with primary tumors (PT) of the cervix (carcinoma of the cervix, CC) or endometrium (endometrioid carcinoma, EDC) and patients receiving the full intended RT dose showed statistically significant better OS in a multivariable cox regression model. Median administered dose was 39 Gy, treatment related acute toxicity was considerably low. Our data show an excellent response rate with a low toxicity profile when administering urgent radiotherapy for tumor related clinically significant bleeding complications. Nonetheless, treatment decisions should be highly individual due to the low median overall survival of this patient group.