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Clinical outcomes of palliative treatment for gastric bleeding from incurable gastric cancer

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Abstract

Purpose

Deciding palliative treatment for gastric bleeding from incurable gastric cancer (IGC) is worrying considering different patient situations and the lack of comprehensive assessment of palliative treatment. We evaluated the clinical outcomes and prognostic factors after palliative treatment for gastric bleeding from IGC.

Methods

We enrolled 48 consecutive patients with gastric bleeding from IGC who underwent palliative surgery (PS) or palliative radiotherapy (PRT).

Results

Of the 48 patients, 23 underwent PS and 25 received PRT. More patients who had an Eastern Cooperative Oncology Group-Performance Status (ECOG-PS) ≥ 2 or who received chemotherapy underwent PRT than underwent PS. Severe complications were observed in 2 (8.6%) patients after PS. After PRT, 22 patients achieved hemostasis (88%), but rebleeding was found in 10 (40%). Chemotherapy was introduced after palliative treatment for 21 (91.3%) patients in the PS group and 17 (68%) patients in the PRT group. The median survival time (MST) of patients with and without chemotherapy after PS was 12.5 and 3.1 months, respectively (p ≤ 0.001), while the MST of patients with and without chemotherapy after PRT was 6.5 and 1.6 months (p < 0.001). Multivariate analyses identified ECOG-PS, tumor size, and chemotherapy after palliative treatment as independent risk factors.

Conclusions

Palliative treatment strategies for gastric bleeding should be determined with consideration of the general condition, previous chemotherapy, and chemotherapy after palliative treatment.

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References

  1. Ajani JA, D’Amico TA, Almhanna K, Bentrem DJ, Chao J, Das P, et al. Gastric cancer, Version 3.2016, NCCN clinical practice guidelines in oncology. J Natl Compr Canc Netw. 2016;14:1286–312.

    Article  PubMed  Google Scholar 

  2. Smyth EC, Verheij M, Allum W, Cunningham D, Cervantes A, Arnold D, et al. Gastric cancer: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2016;27:v38-49.

    Article  CAS  PubMed  Google Scholar 

  3. Japanese Gastric Cancer Association. Japanese gastric cancer treatment guidelines 2018, 5th ed. Gastric Cancer. 2021;24:1–21.

    Article  Google Scholar 

  4. Koizumi W, Narahara H, Hara T, Takagane A, Akiya T, Takagi M, et al. S-1 plus cisplatin versus S-1 alone for first-line treatment of advanced gastric cancer (SPIRITS trial): a phase III trial. Lancet Oncol. 2008;9:215–21.

    Article  CAS  PubMed  Google Scholar 

  5. Bang YJ, Van Cutsem E, Feyereislova A, Chung HC, Shen L, Sawaki A, et al. Trastuzumab in combination with chemotherapy versus chemotherapy alone for treatment of HER2-positive advanced gastric or gastro-oesophageal junction cancer (ToGA): a phase 3, open-label, randomised controlled trial. Lancet. 2010;376:687–97.

    Article  CAS  PubMed  Google Scholar 

  6. Yamada Y, Higuchi K, Nishikawa K, Gotoh M, Fuse N, Sugimoto N, et al. Phase III study comparing oxaliplatin plus S-1 with cisplatin plus S-1 in chemotherapy-naïve patients with advanced gastric cancer. Ann Oncol. 2015;26:141–8.

    Article  CAS  PubMed  Google Scholar 

  7. Yagi S, Yamada K, Terayama M, Wake H, Enomoto N, Nohara K, et al. Current status of doublet combinations of platinum and fluoropyrimidines using oxaliplatin for advanced gastric cancer. Glob Health Med. 2021;3:31–6.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Fujitani K, Yang H-K, Mizusawa J, Kim YW, Terashima M, Han SU, et al. Gastrectomy plus chemotherapy versus chemotherapy alone for advanced gastric cancer with a single non-curable factor (REGATTA): a phase 3, randomised controlled trial. Lancet Oncol. 2016;17:309–18.

    Article  CAS  PubMed  Google Scholar 

  9. Kunisaki C, Makino H, Takagawa R, Oshima T, Nagano Y, Fujii S, et al. Impact of palliative gastrectomy in patients with incurable advanced gastric cancer. Anticancer Res. 2008;28:1309–15.

    PubMed  Google Scholar 

  10. Dittmar Y, Rauchfuss F, Goetz M, Jandt K, Scheuerlein H, Heise M, et al. Non-curative gastric resection for patients with stage 4 gastric cancer–a single center experience and current review of literature. Langenbecks Arch Surg. 2012;397:745–53.

    Article  PubMed  Google Scholar 

  11. Lasithiotakis K, Antoniou SA, Antoniou GA, Kaklamanos I, Zoras O. Gastrectomy for stage IV gastric cancer. A systematic review and meta-analysis. Anticancer Res. 2014;34:2079–85.

    PubMed  Google Scholar 

  12. Tokunaga M, Makuuchi R, Miki Y, Tanizawa Y, Bando E, Kawamura T, et al. Surgical and survival outcome following truly palliative gastrectomy in patients with incurable gastric cancer. World J Surg. 2016;40:1172–7.

    Article  PubMed  Google Scholar 

  13. Hashimoto K, Mayahara H, Takashima A, Nakajima TE, Kato K, Hamaguchi T, et al. Palliative radiation therapy for hemorrhage of unresectable gastric cancer: a single institute experience. J Cancer Res Clin Oncol. 2009;135:1117–23.

    Article  PubMed  Google Scholar 

  14. Asakura H, Hashimoto T, Harada H, Mizumoto M, Furutani K, Hasuike N, et al. Palliative radiotherapy for bleeding from advanced gastric cancer: is a schedule of 30 Gy in 10 fractions adequate? J Cancer Res Clin Oncol. 2011;137:125–30.

    Article  CAS  PubMed  Google Scholar 

  15. Tey J, Zheng H, Soon YY, Leong CN, Koh WY, Lim K, et al. Palliative radiotherapy in symptomatic locally advanced gastric cancer: a phase II trial. Cancer Med. 2019;8:1447–58.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Barber CR. Health care in developing countries. Lancet. 1992;340:1415.

    Article  CAS  PubMed  Google Scholar 

  17. Kanda Y. Investigation of the freely available easy-to-use software “EZR” for medical statistics. Bone Marrow Transplant. 2013;48:452–8.

    Article  CAS  PubMed  Google Scholar 

  18. Hartgrink HH, Putter H, Klein Kranenbarg E, Bonenkamp JJ, van de Velde CJ. Dutch gastric cancer group. Value of palliative resection in gastric cancer. Br J Surg. 2002;89:1438–43.

    Article  CAS  PubMed  Google Scholar 

  19. Fleissig A, Jenkins V, Catt S, Fallowfield L. Multidisciplinary teams in cancer care: are they effective in the UK? Lancet Oncol. 2006;7:935–43.

    Article  PubMed  Google Scholar 

  20. Katz MH, Wang H, Fleming JB, Sun CC, Hwang RF, Wolff RA, et al. Long-term survival after multidisciplinary management of resected pancreatic adenocarcinoma. Ann Surg Oncol. 2009;16:836–47.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Manganoni AM, Farisoglio C, Ferrari V, Zaniboni A, Beretta G, Meriggi F, et al. Multidisciplinary team-working indicators of good practice in the clinical management of EGFR-inhibitor dermatologic toxicities. Ann Surg Oncol. 2009;16:224–5.

    Article  PubMed  Google Scholar 

  22. Dozois EJ, Wall JC, Spinner RJ, Jacofsky DJ, Yaszemski MJ, Sim FH, et al. Neurogenic tumors of the pelvis: clinicopathologic features and surgical outcomes using a multidisciplinary team. Ann Surg Oncol. 2009;16:1010–6.

    Article  PubMed  Google Scholar 

  23. Wright FC, Lookhong N, Urbach D, Davis D, McLeod RS, Gagliardi AR. Multidisciplinary cancer conferences: identifying opportunities to promote implementation. Ann Surg Oncol. 2009;16:2731–7.

    Article  CAS  PubMed  Google Scholar 

  24. Tey J, Choo BA, Leong CN, Loy EY, Wong LC, Lim K, et al. Clinical outcome of palliative radiotherapy for locally advanced symptomatic gastric cancer in the modern era. Medicine. 2014;93: e118.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Tanaka O, Sugiyama A, Omatsu T, Tawada M, Makita C, Matsuo M. Hemostatic radiotherapy for inoperable gastric cancer: a pilot study. Br J Radiol. 2020;93:20190958.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Tey J, Soon YY, Koh WY, Leong CN, Choo BA, Ho F, et al. Palliative radiotherapy for gastric cancer: a systematic review and meta-analysis. Oncotarget. 2017;8:25797–805.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Kim MM, Rana V, Janjan NA, Das P, Phan AT, Delclos ME, et al. Clinical benefit of palliative radiation therapy in advanced gastric cancer. Acta Oncol. 2008;47:421–7.

    Article  PubMed  Google Scholar 

  28. Terashima M, Fujitani K, Ando M, Sakamaki K, Kawabata R, Ito Y, et al. Survival analysis of a prospective multicenter observational study on surgical palliation among patients receiving treatment for malignant gastric outlet obstruction caused by incurable advanced gastric cancer. Gastric Cancer. 2021;24:224–31.

    Article  PubMed  Google Scholar 

  29. Takahari D. Second-line chemotherapy for patients with advanced gastric cancer. Gastric Cancer. 2017;20:395–406.

    Article  PubMed  Google Scholar 

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Acknowledgements

We thank Minako Sumi (Radiation Oncology, Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology) for her support in data collection. We would also like to thank Enago (www.enago.jp) for the English language review.

Funding

This study received no external funding.

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Authors and Affiliations

  1. Department of Gastroenterology, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan

    Shusuke Yagi, Satoshi Ida, Ken Namikawa, Masaru Hayami, Rie Makuuchi, Koshi Kumagai, Manabu Ohashi, Takeshi Sano & Souya Nunobe

  2. Department of Surgery, National Center for Global Health and Medicine, Tokyo, Japan

    Shusuke Yagi

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  1. Shusuke Yagi
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Contributions

SY, SI, and SN devised the design of the work. SY wrote the manuscript. SI and SN edited the manuscript. NK, MH, RM, KK, MO, and TS helped draft the manuscript. SN gave final approval of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Souya Nunobe.

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The authors declare no conflicts of interest in association with the present study.

Ethics statements

This study was approved by the Institutional Review Board (No. 2018–1211). All patients provided informed consent for the analysis.

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Yagi, S., Ida, S., Namikawa, K. et al. Clinical outcomes of palliative treatment for gastric bleeding from incurable gastric cancer. Surg Today 53, 360–368 (2023). https://doi.org/10.1007/s00595-022-02567-8

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