World J Oncol

World Journal of Oncology, ISSN 1920-4531 print, 1920-454X online, Open Access

Article copyright, the authors; Journal compilation copyright, World J Oncol and Elmer Press Inc

Journal website http://www.wjon.org

Original Article

Volume 7, Number 2-3, June 2016, pages 29-33

A Nationwide Survey in Japan of Palliative Radiotherapy for Bleeding in Gastrointestinal and Genitourinary Tumor Patients

Figure 2. Relationship between dose per fraction and number of fractions. The bubble size represents the number of answers. The dashed line indicates the biologically equivalent dose (BED) of 39 Gy₁₀ by using a tumor alpha/beta ratio of 10.

**Table 1.** The Survey’s Three Hypothetical Patients With GI or GU Cancer
ECOG: Eastern Cooperative Oncology Group.
Case 1	A 65-year-old male with ECOG performance status 1 who was diagnosed with gastric cancer involving multiple hepatic metastases 6 months ago. His response to chemotherapy has been poor, and the disease is progressing. The patient requires blood transfusion approximately once weekly due to bleeding from the primary lesion. There are no alternative hemostatic approaches.
Case 2	A 75-year-old female with ECOG performance status 2 who was diagnosed with rectal cancer involving multiple hepatic and pulmonary metastases 1 year earlier. She has undergone multiple chemotherapy sessions. The continuation of chemotherapy is difficult due to myelosuppression. The presence of hematochezia involving bleeding from the primary lesion in the rectum has been macroscopically confirmed. Although blood transfusion is not required at present, the hemoglobin level is decreasing. There are no alternative hemostatic approaches.
Case 3	An 80-year-old male with ECOG performance status 1 who was diagnosed with bladder cancer involving bone 1 month earlier. Chemotherapy has not been applied in consideration of the patient’s age and complication by ischemic heart disease and others. The presence of macroscopic hematuria suggests bleeding from the bladder tumor. Mild anemia is also observed, not requiring blood transfusion at present.

Table 1. The Survey’s Three Hypothetical Patients With GI or GU Cancer

ECOG: Eastern Cooperative Oncology Group.

Case 1

A 65-year-old male with ECOG performance status 1 who was diagnosed with gastric cancer involving multiple hepatic metastases 6 months ago. His response to chemotherapy has been poor, and the disease is progressing. The patient requires blood transfusion approximately once weekly due to bleeding from the primary lesion. There are no alternative hemostatic approaches.

Case 2

A 75-year-old female with ECOG performance status 2 who was diagnosed with rectal cancer involving multiple hepatic and pulmonary metastases 1 year earlier. She has undergone multiple chemotherapy sessions. The continuation of chemotherapy is difficult due to myelosuppression. The presence of hematochezia involving bleeding from the primary lesion in the rectum has been macroscopically confirmed. Although blood transfusion is not required at present, the hemoglobin level is decreasing. There are no alternative hemostatic approaches.

Case 3

An 80-year-old male with ECOG performance status 1 who was diagnosed with bladder cancer involving bone 1 month earlier. Chemotherapy has not been applied in consideration of the patient’s age and complication by ischemic heart disease and others. The presence of macroscopic hematuria suggests bleeding from the bladder tumor. Mild anemia is also observed, not requiring blood transfusion at present.

**Table 2.** Dose Schedules Submitted for Cases of Bleeding (n = 54)*
Dose/fraction (Gy)	n (%)	Median no. of fractions (range)
*Since multiple answers were allowed, the data do not necessarily add up to 54.
Case 1
> 3.0	3 (4.8)	5
3.0	33 (52.4)	10 (10 - 15)
2.5	9 (14.3)	16 (14 - 18)
2.4	1 (1.6)	15
2.0	16 (26.7)	20 (10 - 30)
1.8	1 (1.6)	25
No indication	0
Total	63	10 (5 - 30)
Case 2
> 3.0	1 (1.7)	5
3.0	33 (55.0)	10 (10 - 18)
2.5	9 (15.0)	16 (16 - 20)
2.4	0 (0)
2.0	14 (23.3)	25 (15 - 30)
1.8	3 (5.0)	28 (25 - 33)
No indication	3 (5.0)
Total	60	14 (5 - 33)
Case 3
> 3.0	2 (3.3)	7.5 (5 - 10)
3.0	16 (26.7)	10 (10 - 15)
2.5	9 (15.0)	20 (16 - 20)
2.4	0
2.0	29 (48.3)	25 (20 - 30)
1.8	2 (3.3)	29 (28 - 30)
No indication	2 (3.3)
Total	60	20 (5 - 30)

Table 2. Dose Schedules Submitted for Cases of Bleeding (n = 54)*

Dose/fraction (Gy)

n (%)

Median no. of fractions (range)

*Since multiple answers were allowed, the data do not necessarily add up to 54.

Case 1

> 3.0

3 (4.8)

3.0

33 (52.4)

10 (10 - 15)

2.5

9 (14.3)

16 (14 - 18)

2.4

1 (1.6)

2.0

16 (26.7)

20 (10 - 30)

1.8

1 (1.6)

No indication

Total

10 (5 - 30)

Case 2

> 3.0

1 (1.7)

3.0

33 (55.0)

10 (10 - 18)

2.5

9 (15.0)

16 (16 - 20)

2.4

0 (0)

2.0

14 (23.3)

25 (15 - 30)

1.8

3 (5.0)

28 (25 - 33)

No indication

3 (5.0)

Total

14 (5 - 33)

Case 3

> 3.0

2 (3.3)

7.5 (5 - 10)

3.0

16 (26.7)

10 (10 - 15)

2.5

9 (15.0)

20 (16 - 20)

2.4

2.0

29 (48.3)

25 (20 - 30)

1.8

2 (3.3)

29 (28 - 30)

No indication

2 (3.3)

Total

20 (5 - 30)