Efficacy of Radiotherapy for Hemostasis in Tumor-Related Bleeding

Introduction: Hemorrhage is a common complication of malignancy. When undergoing invasion and angiogenesis, malignancies can produce highly vascular lesions with friable and disorganized vessels that are prone to bleeding (Hughes and Radhakrishna, Br J Hosp Med (Lond), 2019). Among patients with advanced cancer, around 10% have bleeding symptoms, which can impact both the quality and quantity of life (Katano and Yamashita, Cureus, 2021). Palliative radiotherapy (RT) has been associated with achieving hemostasis in a variety of bleeding malignancies, including gastric, bladder, lung, and gynecologic cancers. The goal of this study was to better determine the efficacy of radiotherapy in reducing transfusion requirements.

Methods: A retrospective chart review of patients was performed after IRB approval. Patients who received radiation for controlling malignancy-associated hemorrhage were included in this study. The outcome measure was change in red blood cell (RBC) transfusion requirements from the month prior to the month following palliative RT. Data was obtained from the institution's electronic medical record. Change in transfusion requirements was analyzed using Welch's t-test and bleeding recurrence was analyzed using the exact test of goodness-of-fit.

Results: A total of 6002 patients were screened and 30 cases (63.3% female, average age at radiation treatment 62 years) were included in the study with RT treatment dates 2019-2023. Sixteen malignancy types were represented, with pancreatic adenocarcinoma and endometrial adenocarcinoma being the most common (both 4, 13.3%). Median radiation dose was 13 Gy (range 3-30) delivered over a median of 3.5 fractions (range 1-10). Bleeding was not noted to recur in 73.3% of the cases ( P = 0.02). For those patients with recurrent bleeding, median time from RT to recurrent bleeding was 58 days (range 11-544). Transfusion requirements decreased from an average of 2.7 RBC units over one month prior to completion of RT to 1.1 units for the month following completion of RT ( P = 0.03). Median survival after completion of RT was 132 days (range 3-698).

Conclusion: This study showed that radiation therapy resulted in apparent cessation of hemorrhage in over 70% of cases of hemorrhagic malignancies with a significant decrease in RBC transfusion requirements over one month. This suggests that RT is effective in stopping hemorrhage in a variety of malignancies as well as reducing transfusion requirements. More work is needed to test this hypothesis on larger populations, as well as investigation on the mechanism by which RT results in hemostasis.