Tumour bleeding: Efficacy and outcome of haemostatic radiotherapy

Background. Management of tumour bleeding remains a challenge in oncology. With a number of methods available, radiotherapy still holds a crucial place. There are no standard guidelines for dose fractionation of haemostatic radiotherapy (HRT), and it varies from case to case. We aimed to study the effectiveness of HRT. Methods. We retrospectively analysed the effectiveness of HRT in 70 patients in terms of control of bleeding and overall survival, who presented to us with advanced cancers from July 2014 to June 2017. Results. The median age was 48 (range 23–76) years, and male to female ratio was 2.18:1. The most common malignancy encountered was lung and gynaecological (both 17.1%). Stage IV was the most common stage (48.6%) of the primary tumour. The site of bleeding was the primary tumour in 50 (71.4%) patients, whereas fungating regional nodes were the cause in the remaining. The median duration between initial diagnosis and HRT was 5 (range 0–19) months. Seventeen patients (24.3%) had a history of prior radiotherapy. Fifty-one patients (72.8%) required at least 1 unit of blood transfusion. Hypofractionated HRT schedules were used in all patients with the most common being 30 Gy in 10 daily fractions for 5 days a week (18, 25.7%). At the end of HRT, bleeding was effectively controlled in 53 patients (75.7%). The median survival was 13 (range 1–26) months. The 1- and 2-year survival rates were 55.7% and 4.3%, respectively. Conclusions. HRT is safe and effective in achieving haemostasis in advanced tumours presenting with bleeding from either the primary or the regional lymph nodes. Although optimal dose fractionation has not yet established, hypofractionated radiotherapy is preferred, with the total dose depending on several factors. However, the overall prognosis remains poor.