Clinical benefit of palliative radiation therapy in advanced gastric cancer

Background. Local progression of advanced gastric cancer often manifests as bleeding, dysphagia/obstruction, or pain. We evaluated the magnitude and durability of palliation with radiotherapy (RT). Material and methods. From 1996 to 2004, 37 gastric cancer patients were treated with palliative RT ( median dose 35Gy in 14 fractions). Nearly two-thirds of all patients received concurrent chemoradiation therapy ( CRT). Index pre-treatment symptoms were gastric bleeding, dysphagia/obstruction, and pain in 54%, 43%, and 19% of patients, respectively. Results. The rates of control for bleeding, dysphagia/obstruction, and pain were 70% ( 14/ 20), 81% ( 13/16), and 86% ( 6/7), respectively. These symptoms were controlled without additional interventions for a median of 70%, 81%, and 49% of the patient's remaining life, respectively. Patients receiving CRT had a trend towards better median overall survival than those receiving RT alone ( 6.7 vs. 2.4 months, p = 0.08). Lower ( <41 Gy) biologically effective dose ( BED, assuming an alpha/beta ratio of 10 for early responding tissues) predicted for poorer local control ( 6-month local control 70% vs. 100%, p = 0.05) while T4 tumors had a trend towards inferior local control ( 6-month LC 56% vs. 100%, p = 0.06). Discussion. Palliative RT controls symptoms for most of the remaining life in the majority of gastric cancer patients. The role of a higher dose of RT ( BED >= 41 Gy), especially in patients with T4 tumors, remains to be established. In order to accurately define the role for radiotherapy in palliation of these symptoms, prospective randomized studies need to be conducted.