Haemostatic Radiotherapy

Haemostatic Radiotherapy

• 1.
  Haemostatic Radiotherapy Dr. AasthaShah MD Radiation Oncology
• 2.
  • Tumor bleedingpose a major challenge in oncology. • Almost 10% of the advanced tumors present with bleeding. • Presentation as: vaginal bleed in gyneclogical malignancies,hemoptysis in lung cancers,hematuria in bladder cancers,malena or fresh bleed in GI tumors and oral cavity bleeds.
• 3.
  • Bleeding mayeven occur from fungating lymph node masses,orbital masses. • Base of tongue tumors typically present with bleeding at advanced stages and are life threatening.
• 4.
  • Tumor vesselslack proper architecture and hence do not get easily controlled by pharmacological drugs like adrenaline as they lack proper smooth muscle layer and thus do not constrict and eventually bleed uncontrollably.
• 5.
  • Depending onseverity,bleeding can be managed by: • Compression bandages • Adrenaline • Radiotherapy • Ligation of bleeders • Radioembolization • Transfusion of blood products ultimately.
• 6.
  • Radiotherapy canbe delivered either via teletherapy or brachytherapy for hemostatic purpose. • The acute control mechanism is via increased platelet adhesion to vascular endothelium and long term effect is via vessel fibrosis combined with tumor shrinkage.
• 7.
  • High doseper fraction have been typically used for hemostatic purpose.Hypofractionation schedules have proven to be useful for both tumor control and patient compliance. • Bleeding generally stops in 24 to 48 hours and usually after a BED of 20 Gy has been delivered. • Typical dose schedules: • 8 Gy/# • 12 Gy/3#
• 8.
  • 15 Gy/5# •20 Gy/5# • 30 Gy/10# • 40 Gy/20#
• 9.
  • The intentof hemostatic RT is palliative so just the gross bleeding mass with minimum margin should be treated. • However after a substantial response if obtained the regimen can be converted to a curative one adjusting the BED and dose fractionation.
• 10.
  • Bleeding tumorsconstitute an oncologic emergency and hemostatic RT has been used since ages with a very well response.