Faculty Collaboration Database

Clinical benefit of palliative radiation therapy in advanced gastric cancer. Acta Oncol 2008;47(3):421-7

Date

09/28/2007

Pubmed ID

17899453

DOI

10.1080/02841860701621233

Scopus ID

2-s2.0-40949086457 (requires institutional sign-in at Scopus site)   82 Citations

Abstract

BACKGROUND: Local progression of advanced gastric cancer often manifests as bleeding, dysphagia/obstruction, or pain. We evaluated the magnitude and durability of palliation with radiotherapy (RT).

MATERIAL AND METHODS: From 1996 to 2004, 37 gastric cancer patients were treated with palliative RT (median dose 35 Gy in 14 fractions). Nearly two-thirds of all patients received concurrent chemoradiation therapy (CRT). Index pre-treatment symptoms were gastric bleeding, dysphagia/obstruction, and pain in 54%, 43%, and 19% of patients, respectively.

RESULTS: The rates of control for bleeding, dysphagia/obstruction, and pain were 70% (14/20), 81% (13/16), and 86% (6/7), respectively. These symptoms were controlled without additional interventions for a median of 70%, 81%, and 49% of the patient's remaining life, respectively. Patients receiving CRT had a trend towards better median overall survival than those receiving RT alone (6.7 vs. 2.4 months, p=0.08). Lower (<41 Gy) biologically effective dose (BED, assuming an alpha/beta ratio of 10 for early responding tissues) predicted for poorer local control (6-month local control 70% vs. 100%, p=0.05) while T4 tumors had a trend towards inferior local control (6-month LC 56% vs. 100%, p=0.06).

DISCUSSION: Palliative RT controls symptoms for most of the remaining life in the majority of gastric cancer patients. The role of a higher dose of RT (BED >or=41 Gy), especially in patients with T4 tumors, remains to be established. In order to accurately define the role for radiotherapy in palliation of these symptoms, prospective randomized studies need to be conducted.

Author List

Kim MM, Rana V, Janjan NA, Das P, Phan AT, Delclos ME, Mansfield PF, Ajani JA, Crane CH, Krishnan S

Author

Alexandria T. Phan MD Professor in the Medicine department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adenocarcinoma
Adult
Aged
Aged, 80 and over
Antineoplastic Combined Chemotherapy Protocols
Combined Modality Therapy
Deglutition Disorders
Disease Progression
Female
Gastrectomy
Gastrostomy
Humans
Jejunostomy
Male
Middle Aged
Neoplasms, Multiple Primary
Pain
Palliative Care
Radiotherapy Dosage
Radiotherapy, Adjuvant
Radiotherapy, High-Energy
Retrospective Studies
Stomach Neoplasms