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Original article
peer-reviewed

Bleeding in Locally Invasive Pelvic Malignancies: Is Hypofractionated Radiation Therapy a Safe and Effective Non-Invasive Option for Securing Hemostasis? A Single Institution Perspective



Abstract

Introduction: Control of bleeding due to locally invasive disease is of paramount importance in the management of cancer patients. This study was undertaken to explore the outcomes of palliative intent hypofractionated radiation therapy (HRT) in advanced stage pelvic malignancies that presented with bleeding.

Methods: This study enrolled patients treated with palliative intent hypofractionated radiation therapy from July 2015 to November 2017. In the inclusion criteria, all these patients had the common presenting complaint of bleeding from the tumor. These patients were not treated with radiation therapy before for the same indication. Patients with known bleeding disorders and those undergoing parallel interventions for bleeding control were excluded from the study. Bleeding was categorized based on the World Health Organization (WHO) scale for the classification of bleeding. Response assessment was classified into a complete response, partial response and no response. A comparison was made for the bleeding scale before and after HRT using the Wilcoxon signed rank test. The comparison of mean hemoglobin levels before and after the HRT was calculated by paired t-test.

Results: Forty-two patients with advanced pelvic malignancies qualified for inclusion in the study after applying the inclusion/exclusion criteria. Among those analyzed, the median age was 67 years (range 37 – 95 years). The male and female proportion was 38% and 62% respectively. Different cancers included uterine cancer 31%, cervical cancer 24%, bladder cancer 21%, rectal cancer 17% and vulvar cancer in 7%. The baseline bleeding scale in these cases was found to be grade 1 in 12%, grade 2 in 55% and grade 3 in 33% cases. The median dose in our cohort was 20 Gy in five fractions over one week (range was 8 Gy to 40 Gy). Following HRT, the WHO bleeding score at one month was recorded as grade 0 in 57%, grade 1 in 31%, grade 2 in 7%, grade 3 in 5% and grade 4 in none. Toxicity profile did not show any grade 3 or above acute toxicity in the study. Response rates were 57% complete response, 36% partial response and 7% no response. The mean hemoglobin level post-treatment versus pre-treatment was found to be 9.6 g/dL versus 7.3 g/dL.

Conclusions: Hypofractionated radiotherapy was found to be a safe and effective non-invasive palliative treatment modality for securing hemostasis in advanced pelvic malignancies that presented with bleeding.



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Original article
peer-reviewed

Bleeding in Locally Invasive Pelvic Malignancies: Is Hypofractionated Radiation Therapy a Safe and Effective Non-Invasive Option for Securing Hemostasis? A Single Institution Perspective


Author Information

Muhammad Shuja Corresponding Author

Department of Radiation Oncology, King Fahad Medical City, Riyadh, Saudi Arabia

Saadiya Nazli

Department of Transfusion Medicine, King Khalid University Hospital, King Saud University - Medical City, Riyadh, Saudi Arabia

Muhammad Atif Mansha

Section of Radiation Oncology, Department of Oncology, Aga Khan University Hospital, Karachi, Pakistan

Asif Iqbal

Medical Physics Department, King Fahad Medical City, Riyadh, Saudi Arabia

Reham Mohamed

Department of Radiation Oncology, King Fahad Medical City, Riyadh, Saudi Arabia, Department of Radiation Oncology, National Cancer Institute, Cairo University, Cairo, Egypt

Mutahir A. Tunio

Department of Radiation Oncology, King Fahad Medical City, Riyadh, Saudi Arabia

Eyad F. Alsaeed

Department of Radiation Oncology, King Khalid University Hospital, King Saud University - Medical City, Riyadh, Saudi Arabia

Mushabbab Asiri

Department of Radiation Oncology, King Fahad Medical City, Riyadh, Saudi Arabia

Yasser Bayoumi

Radiation Oncology Department, KFMC


Ethics Statement and Conflict of Interest Disclosures

Human subjects: Consent was obtained by all participants in this study. KFMC Institutional Review Board (IRB) issued approval 10471. All the data was collected, stored, and analyzed in a de-identified form (without patient name or date of birth). The data was kept under lock and key, under the custody of the principal investigator. No patient identifying information has been used in the text of this article. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.


Original article
peer-reviewed

Bleeding in Locally Invasive Pelvic Malignancies: Is Hypofractionated Radiation Therapy a Safe and Effective Non-Invasive Option for Securing Hemostasis? A Single Institution Perspective


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Original article
peer-reviewed

Bleeding in Locally Invasive Pelvic Malignancies: Is Hypofractionated Radiation Therapy a Safe and Effective Non-Invasive Option for Securing Hemostasis? A Single Institution Perspective

  • Author Information
    Muhammad Shuja Corresponding Author

    Department of Radiation Oncology, King Fahad Medical City, Riyadh, Saudi Arabia

    Saadiya Nazli

    Department of Transfusion Medicine, King Khalid University Hospital, King Saud University - Medical City, Riyadh, Saudi Arabia

    Muhammad Atif Mansha

    Section of Radiation Oncology, Department of Oncology, Aga Khan University Hospital, Karachi, Pakistan

    Asif Iqbal

    Medical Physics Department, King Fahad Medical City, Riyadh, Saudi Arabia

    Reham Mohamed

    Department of Radiation Oncology, King Fahad Medical City, Riyadh, Saudi Arabia, Department of Radiation Oncology, National Cancer Institute, Cairo University, Cairo, Egypt

    Mutahir A. Tunio

    Department of Radiation Oncology, King Fahad Medical City, Riyadh, Saudi Arabia

    Eyad F. Alsaeed

    Department of Radiation Oncology, King Khalid University Hospital, King Saud University - Medical City, Riyadh, Saudi Arabia

    Mushabbab Asiri

    Department of Radiation Oncology, King Fahad Medical City, Riyadh, Saudi Arabia

    Yasser Bayoumi

    Radiation Oncology Department, KFMC


    Ethics Statement and Conflict of Interest Disclosures

    Human subjects: Consent was obtained by all participants in this study. KFMC Institutional Review Board (IRB) issued approval 10471. All the data was collected, stored, and analyzed in a de-identified form (without patient name or date of birth). The data was kept under lock and key, under the custody of the principal investigator. No patient identifying information has been used in the text of this article. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

    Acknowledgements


    Article Information

    Published: February 02, 2018

    DOI

    10.7759/cureus.2137

    Cite this article as:

    Shuja M, Nazli S, Mansha M, et al. (February 02, 2018) Bleeding in Locally Invasive Pelvic Malignancies: Is Hypofractionated Radiation Therapy a Safe and Effective Non-Invasive Option for Securing Hemostasis? A Single Institution Perspective. Cureus 10(2): e2137. doi:10.7759/cureus.2137

    Publication history

    Received by Cureus: January 25, 2018
    Peer review began: January 28, 2018
    Peer review concluded: January 28, 2018
    Published: February 02, 2018

    Copyright

    © Copyright 2018
    Shuja et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 3.0., which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

    License

    This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Abstract

Introduction: Control of bleeding due to locally invasive disease is of paramount importance in the management of cancer patients. This study was undertaken to explore the outcomes of palliative intent hypofractionated radiation therapy (HRT) in advanced stage pelvic malignancies that presented with bleeding.

Methods: This study enrolled patients treated with palliative intent hypofractionated radiation therapy from July 2015 to November 2017. In the inclusion criteria, all these patients had the common presenting complaint of bleeding from the tumor. These patients were not treated with radiation therapy before for the same indication. Patients with known bleeding disorders and those undergoing parallel interventions for bleeding control were excluded from the study. Bleeding was categorized based on the World Health Organization (WHO) scale for the classification of bleeding. Response assessment was classified into a complete response, partial response and no response. A comparison was made for the bleeding scale before and after HRT using the Wilcoxon signed rank test. The comparison of mean hemoglobin levels before and after the HRT was calculated by paired t-test.

Results: Forty-two patients with advanced pelvic malignancies qualified for inclusion in the study after applying the inclusion/exclusion criteria. Among those analyzed, the median age was 67 years (range 37 – 95 years). The male and female proportion was 38% and 62% respectively. Different cancers included uterine cancer 31%, cervical cancer 24%, bladder cancer 21%, rectal cancer 17% and vulvar cancer in 7%. The baseline bleeding scale in these cases was found to be grade 1 in 12%, grade 2 in 55% and grade 3 in 33% cases. The median dose in our cohort was 20 Gy in five fractions over one week (range was 8 Gy to 40 Gy). Following HRT, the WHO bleeding score at one month was recorded as grade 0 in 57%, grade 1 in 31%, grade 2 in 7%, grade 3 in 5% and grade 4 in none. Toxicity profile did not show any grade 3 or above acute toxicity in the study. Response rates were 57% complete response, 36% partial response and 7% no response. The mean hemoglobin level post-treatment versus pre-treatment was found to be 9.6 g/dL versus 7.3 g/dL.

Conclusions: Hypofractionated radiotherapy was found to be a safe and effective non-invasive palliative treatment modality for securing hemostasis in advanced pelvic malignancies that presented with bleeding.



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