Recurrent haematochezia in an 85-year-old man with hepatocellular carcinoma

An 85-year-old man with Child-Pugh A cirrhosis secondary to non-alcoholic steatohepatitis presented to casualty with four days of painless haematochezia with dark blood without haemodynamic compromise. This was in the setting of receiving stereotactic body radiation therapy (SBRT) as treatment for his hepatocellular carcinoma (HCC).He was found to have haemorrhagic radiation colitis which was treated with argon plasma coagulation (APC). Our case demonstrates the importance of considering radiation induced colitis as a cause for painless lower gastrointestinal bleeding in patients with a background of radiation therapy for HCC. Earlier review of the imaging and consideration of this differential could have prevented the need for repeat hospitalisations and would have led to prompt colonoscopy and diagnosis.

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Sa1650 – Endorectal Balloon (ERB) During Image Guided Radiation Therapy (IGRT) for Carcinoma of the Prostate (CAP) Reduces Long Term Radiation Induced Rectal Bleeding and Subsequent Argon Plasma Coagulation (APC) Treatment

Gastroenterology ◽

10.1016/s0016-5085(19)37717-0 ◽

2019 ◽

Vol 156 (6) ◽

pp. S-353-S-354

Author(s):

Rochelle J. Botten ◽

Addolorata C. DiMatteo ◽

Kanan Sharma ◽

Philip Dinning ◽

Braden Higgs ◽

...

Keyword(s):

Radiation Therapy ◽

Rectal Bleeding ◽

Argon Plasma Coagulation ◽

Argon Plasma ◽

Plasma Coagulation ◽

Image Guided Radiation Therapy ◽

Image Guided ◽

Endorectal Balloon ◽

Radiation Induced

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Upper GI Bleeding Secondary to Radiation Gastritis in a Patient with Preexisting Portal Hypertensive Gastropathy

Case Reports in Gastroenterology ◽

10.1159/000516569 ◽

2021 ◽

pp. 513-518

Author(s):

Samragnyi Madala ◽

Abhishek Polavarapu ◽

Dhineshreddy Gurala ◽

Vivek Gumaste

Keyword(s):

Radiation Therapy ◽

Gastrointestinal Bleeding ◽

Argon Plasma Coagulation ◽

Argon Plasma ◽

Laser Coagulation ◽

Portal Hypertensive Gastropathy ◽

Gastrointestinal Malignancy ◽

Nonalcoholic Fatty Liver ◽

Increased Risk ◽

Radiation Induced

We commonly see patients presenting with either portal hypertensive gastropathy (PHG) or radiation gastritis. Radiation-induced hemorrhagic gastritis is an unusual lethal complication postradiation. Patients with preexisting PHG have very friable mucosa that can easily bleed after radiation for cancer treatment. There is an increased risk of bleeding with both entities present together. Our aim is to focus on treatment and possible prevention of gastrointestinal bleeding in patients with preexisting PHG undergoing radiation therapy for newly diagnosed cancer. Several therapies like prednisolone, argon plasma coagulation, laser coagulation have been proposed. There are no set guidelines for treatment. In these patients, if radiation therapy is indicated either for hepatic or gastrointestinal malignancy, it is suggested to premedicate with proton pump inhibitors or sucralfate. We describe a case of 73-year-old female who presented with upper gastrointestinal bleeding. She had liver cirrhosis secondary to nonalcoholic fatty liver disease and diagnosed with pancreatic cancer, for which she received chemoradiation. She was found to have both radiation gastritis and PHG with diffuse erythematous, edematous, congested mucosa with diffuse oozing blood in the antrum making it very challenging to treat.

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Repeated CyberKnife stereotactic body radiation therapy in hepatocellular carcinoma

Radiation Oncology ◽

10.1186/s13014-020-1457-z ◽

2020 ◽

Vol 15 (1) ◽

Cited By ~ 1

Author(s):

Jing Sun ◽

Can Ouyang ◽

Xiaoyun Chang ◽

Aimin Zhang ◽

Quan Wang ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Radiation Therapy ◽

Stereotactic Body Radiation Therapy ◽

Medical Center ◽

Survival Rates ◽

Progression Free Survival ◽

Interval Time ◽

Stereotactic Body Radiation ◽

Kaplan Meier ◽

Radiation Induced

Abstract Background To explore the survival and side effects of repeated CyberKnife stereotactic body radiation therapy (CK-SBRT) on hepatocellular carcinoma patients. Methods 24 HCC patients were collected at The Fifth Medical Center of PLA General Hospital from November 2011 to July 2016. They received second-course CK-SBRT with a prescribed dose of 50(48–55) Gy/5-8fx, and a single dose of 10 (7–11) Gy/fx. Cumulative overall survival rates (OS), progression-free survival rates (PFS) and local control rates (LC) were calculated by Kaplan-Meier method. Results All patients finished their radiotherapy plans. The 1-,2- and 3-year cumulative OS rate were 95.8,81.1 and 60.8%. The 1-,2- and 3-year LC rate were 95.5,90.7 and 90.7%, respectively. The 1-, 2- and 3-year PFS were 74.8, 49.2 and 39.4%, respectively. 16 patients complained of fatigue during second-course therapy, 2 patients showed Grade 2 gastrointestinal reaction, 1 patient was diagnosed radiation-induced liver disease and none died. PFS was significantly higher in the interval time < 12 months group than in the interval time ≥ 12 months group (p = 0.030). Conclusions It is preliminarily believed that re-CK-SBRT is an effective and safe treatment for HCC patients, but the treatment criteria should be strictly controlled.

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