3 | DISCUSSION
Our data indicate that RT of 20 Gy in 5 fractions and 30 Gy in 10
fractions can prevent a rapid decline in the hemoglobin level and reduce
the frequency of blood transfusion. From this perspective, palliative RT
can contribute to improving the quality of life of patients with
advanced gastric cancer with bleeding.
There have been several reports on RT for advanced gastric cancer with
bleeding. Lee et al. analyzed hemoglobin and blood transfusion frequency
after RT for 57 patients submitted to palliative RT for gastric bleeding
(7). The authors reported that the mean hemoglobin levels before,
immediately after, and one and two months after RT were significantly
higher than before RT. No significant differences in re-bleeding rates
were observed according to the total dose (17.5–45 Gy), fractional dose
(1.8–5 Gy), or fraction number (4–25 fractions). Tey et al.
investigated approximately 50 patients with advanced gastric cancer (8).
In that study, the median survival duration was 85 days, and 80% of
patients with bleeding responded to RT. Two patients (5%) had grade 3
anorexia and gastritis, but their symptoms resolved after a week. They
received 36 Gy in 12 fractions, and the authors concluded that RT was
effective and well-tolerated. In Japan, no guideline has yet been
established for hemostatic RT for advanced gastric cancer. Taken
together, these data indicate that RT at a total of 20–30 Gy is
effective in alleviating bleeding from advanced gastric cancer.
The optimal dose for achieving hemostasis in cases of advanced gastric
cancer is controversial, as a review by Tey et al. reported wide
inter-study variations in dose fractionation (9). Fraction sizes ranged
from 1.8 to 8 Gy, and total doses ranged from 8 Gy to 50 Gy, with the
most common dose fraction regimen being 30 Gy in 10 fractions. The
response to RT for bleeding ranged from 50% to 80.6%. The median
duration of response ranged from 1.5 to 11.4 months. This review
concluded that there was no marked difference in the response rate of
bleeding between regimens with a high biological equivalent dose (BED)
of ≥39 Gy versus those with a low BED of <39 Gy. Furthermore,
low-BED regimens appear to be adequate for symptom palliation. The BED
for 20 Gy in 5 fractions and for 30 Gy in 10 fractions, as was
administered to the patients in our study, was 28 and 39 Gy,
respectively. Although 30 Gy in 10 fractions is classified as a high BED
of ≥39 Gy, no Grade ≥3 complications were observed in our study.
In summary, we report consecutive seven patients with gastric cancer
with bleeding treated with palliative RT (20 Gy in 5 fractions or 30 Gy
in 10 fractions). The number of blood transfusions decreased
significantly post-RT, supporting the hemostatic effect of palliative
RT.