Radiotherapy in the control of bleeding from primary and secondary lung tumours

Efficacy of palliative hemostatic radiotherapy for tumor bleeding and pain relief in locally advanced pelvic gynecological malignancies

PURPOSE

The appearance of symptomatic tumor-related vaginal bleeding and pain in advanced incurable cancer patients with pelvic gynecological malignancies remains a therapeutic challenge in oncological treatment. The aim of our analysis was to evaluate the efficacy and safety of palliative hemostatic radiotherapy.

METHODS

We retrospectively identified patients who had received palliative hemostatic radiotherapy (RT) at our institution between 2011 and 2023 and evaluated acute toxicity, local control, cessation of bleeding, and pain relief.

RESULTS

In total, 40 patients with a median planning target volume of 804 cm3 were treated with a median total dose of 39 Gy in 13 fractions, resulting in 6‑month and 1‑year local control rates of 66.9 and 60.8%, respectively. No higher-grade (>grade III) acute RT-induced toxicity appeared. Complete cessation of bleeding was achieved in 80.0% of all patients after a median of 16 days and pain relief was documented in 60.9% at first follow-up. 37.5% of the women required a blood transfusion and 25% an additional tamponade with local hemostatic agents. Successful stopping of bleeding was significantly less frequent in patients receiving anticoagulation concurrently with radiation and in the case of infield re-irradiation. Patients with a higher total RT dose had cessation of bleeding significantly more often, with a cut-off value of at least EQD2 (α/β = 10) = 36 Gy. The applied RT technique and planning target volume had no significant influence on the occurrence of bleeding cessation.

CONCLUSION

Palliative hemostatic radiotherapy for locally advanced pelvic gynecological malignancies is safe and effective in achieving high control rates of hemostasis in tumor bleeding and pain relief.

The Perioperative Effects of Preoperative Radiotherapy in Metastatic Spinal Tumor Patients

OBJECTIVE

Radiotherapy is one of the important treatment options for metastatic spinal tumors but is not the definite intervention in all cases, as there are patients who still require surgical treatment because of severe pain or neurologic events after this treatment. We evaluated the perioperative effects of preoperative radiotherapy in these cases as a future guide for surgeons on critical considerations in this period.

METHODS

We included 328 patients in this study who had undergone decompression and fusion surgery for metastatic spinal tumors. Patients who underwent surgery with preoperative radiotherapy were designated as the radiotherapy group (group RT, n = 81), and cases of surgery without preoperative radiotherapy were assigned to the non-radiotherapy group (group nRT, n = 247). We compared the demographic, intraoperative, and postoperative factors between these 2 groups.

RESULTS

In terms of intraoperative factors, statistically significant differences were evident in operation time, estimated blood loss, and transfusion (RT vs. nRT: 188.1 ± 80.7 minutes vs. 231.2 ± 106.1 minutes, 607.2 ± 532.7 mL vs. 830.1 ± 1324.7 mL, and 30.9% vs. 43.3%, P < 0.001, P < 0.031, and P < 0.048, respectively). With regard to postoperative factors, the incidence of infection, wound problems, and local recurrence were statistically higher in group RT (RT vs. nRT: 6.2% vs. 0.8%, 12.3% vs. 0.8%, 23.4% vs. 13.7%, P = 0.004, P < 0.001, and P = 0.038, respectively).

CONCLUSIONS

Preoperative radiotherapy has the intraoperative advantages of reducing bleeding and shortening the operating time, but postoperative caution is needed because of the possibility of infection, wound problems, and local recurrence increases.

Radiation treatment for refractory endometriosis: a 38-year-old female presenting with vaginal bleeding

Background

Endometriosis is typically managed with a medical or surgical approach, though some patients have medically refractory disease and are poor surgical candidates.

Case presentation

A 39-year-old woman presented to our facility with uncontrolled bleeding and pain from an endometriotic mass at the vaginal cuff. She had a history of abdominal hysterectomy with bilateral salpingo-oophorectomy, now with medically refractive and inoperable disease due to prior history of vesicovaginal fistula. We prescribed 30 Gy in 10 fractions with 10 MV and 18 MV photons to the target. At follow-up our patient reported a complete resolution of bleeding and pelvic pain.

Conclusion

Radiation treatment can be an effective treatment for refractory endometriosis.

Incidence and risk factors for pneumonitis among patients with lung cancer who received immune checkpoint inhibitors after palliative thoracic radiotherapy

The aim of this study is to analyze the incidence and risk factors for pneumonitis when immune checkpoint inhibitors (ICIs) are combined with palliative thoracic radiotherapy (RT) for lung cancer. We retrospectively evaluated 29 patients with lung cancer who received ICIs after palliative thoracic RT (30 Gy in 10 fractions). Their ICIs were pembrolizumab (n = 17), nivolumab (n = 8) and atezolizumab (n = 4). Median follow-up period was 10 months. The median interval between starting RT and starting ICI was 25 days. Pneumonitis events were grade 1 (n = 10; 34%), grade 2 (n = 4; 14%) and grade 3 (n = 3; 10%). Obstructive pneumonia was significantly associated with grade ≥ 2 pneumonitis (P = 0.036). Age, sex, ICI agent, interval between RT and ICI and history of ICI before RT were not associated with grade ≥ 2 pneumonitis. Tumor volume; Brinkman index; dosimetric factors, such as lung V5, V10, V20, V30 and mean lung dose (MLD); lactate dehydrogenase; and C-reactive protein did not significantly differ between the grade ≤ 1 and grade ≥ 2 pneumonitis groups. Levels of sialylated carbohydrate antigen KL-6 were evaluated in 27 patients before RT; they significantly differed between patients with grade ≤ 2 pneumonitis (mean: 431 U/ml) and those with grade ≥ 3 pneumonitis (mean: 958 U/ml; P < 0.001). Patients who receive ICI after palliative thoracic RT should be carefully followed-up, especially those who have had obstructive pneumonia or high KL-6 levels.