2 | CASE SERIES
Patients with pathologically-confirmed unresectable gastric cancer who met the following criteria were retrospectively analyzed: (i) bleeding from gastric cancer confirmed by endoscopic or bleeding signs as hematemesis or melena; (ii) treated with palliative RT for hemostatic purposes at Sano Kosei General Hospital between April 2019 and December 2021; and (iii) followed for at least two months post-RT. As a result, 7 patients were considered eligible for the analysis, and the median follow-up period was 5 (range, 2–9) months (Table 1 ).
All patients were treated with external-beam three-dimensional conformal RT using 10 MV-photons. Treatment planning was performed using Monaco (Elekta Co., Ltd., Stockholm, Sweden). The clinical target volume was defined as the gross tumor volume with 5-mm outward margins identified by computed tomography (Figure 1 ). Using a Synergy irradiator (Elekta), 3 and 4 patients received a total of 20 Gy in 5 fractions and 30 Gy in 10 fractions, respectively, in a 5-fractions-per-week schedule. No patients received re-irradiation for gastric cancer.
Notably, compared to 2 months before RT, the number of blood transfusions was significantly decreased in the 2 months after RT (2.42 ± 1.72 vs. 0.14 ± 0.38, p = 0.0121 assessed by the pairedt -test) (Table 2 ). In three-quarters of the 30-Gy patients, hemoglobin levels increased after irradiation. In contrast, the hemoglobin levels in the 20-Gy patients continuously increased in only 1 case (Figure 2 ). No adverse events of Grade ≥3 as assessed by the Common Terminology Criteria for Adverse Event (version 4.0) were observed in any patients.