Usefulness of Palliative Radiotherapy in Reducing the Frequency of Red Blood Cell Transfusion in Patients with Malignant Tumor Bleeding

Purpose: We aimed to evaluate the usefulness of palliative radiotherapy in reducing the frequency of red blood cell (RBC) transfusions in patients with malignant tumor bleeding as a quantitative value to evaluate the hemostatic effect.Patients and methods: In this study, we conducted a retrospective review of patients visiting our department between June 2013 and April 2021. All patients underwent RBC transfusions for 30 days before the initiation of radiotherapy. We determined the overall survival time and RBC transfusion-free time using statistical tests.Results: In total, 21 patients were enrolled in our study, including 13 women and 8 men; the median patient age was 63 years (range: 32 to 82 years). After radiotherapy, 19 of the 21 patients had a decreased frequency of requirement for RBC transfusion compared to that before radiotherapy. Fourteen patients had achieved an RBC transfusion-free state one month after radiotherapy. The estimated 1-year overall survival and RBC transfusion-free rates were 36.3% (95% confidence interval [CI]: 14.2%) and 66.7% (95% CI: 42.5%–42.5 %), respectively.Conclusion: The present study revealed a reduction in RBC transfusion after palliative radiotherapy in patients with malignant tumor bleeding. We believe that reducing the frequency of blood transfusions in patients with terminal conditions would have significant clinical benefits.

Coexistence of gastric cancer and gastric GIST with intra-tumor bleeding: successful embolization with subsequent total gastrectomy

Background Gastrointestinal stromal tumor (GIST) is a rare tumor, however, simultaneous development of gastric cancer and gastric GIST has been documented more frequently in recent years. Rupture of gastric GIST is even more rare and occurred in 7% of all GISTs. Although ruptured GIST might be occasionally difficult to be managed by endoscopy, transcatheter arterial embolization (TAE) was reported to control bleeding from GIST effectively. We report herein a case of coexistence of gastric cancer and gastric GIST with progressing intra-tumor bleeding managed successfully by TAE and review the clinicopathological characteristics of this rare condition reported previously in the Japanese literature. Case presentation A 75-year-old woman with dyspnea and systemic edema was diagnosed as simultaneous occurrence of gastric cancer (histopathologically detected tubular adenocarcinoma pT2N1M0 fStageIIA) and gastric GIST (65 × 92 mm in diameter at the anterior wall of the fornix) with intra-tumor hemorrhage. Perceiving the progress of bleeding from tumor growth and exacerbating anemia, TAE of left gastric artery was performed. Then remission of anemia has been obtained, the patient underwent an elective radical surgery. Conclusions Simultaneous occurrence of gastric cancer and gastric GIST was speculated to be more common. TAE for ruptured GIST may be effective for hemostasis and reduction of tumor burden, which could facilitate minimal invasive surgery.

Primary Intracranial Malignant Melanomas in Solitary Type: A Tertiary Center Experience

Purpose Solitary type primary intracranial malignant melanoma (PIMM) is extremely rare but fatal. The optimal treatment algorithm according to clinical relevance of symptoms and outcomes is unclear. This series emphasized the prognostic factors of solitary PIMM and established the treatment algorithm for this rare disease. Methods Patients with solitary PIMMs were pathologically verified and treated with neurosurgical tumor resection. All solitary PIMMs recruited at our institute received multidisciplinary team care. We analyzed the clinical findings and prognostic factors. Results The study cohort included 10 patients. PIMMs in solitary type impacted middle-aged populations with male predominance in Taiwan. Most patients (80%) presented a single tumor initially. Six patients had progressed to multiplicity after the initial treatment. Rates of tumor bleeding and leptomeningeal metastasis (LM) are high in solitary PIMMs. Patients who had gross-total resection (GTR) had better survival than those who had incomplete resection, with median overall survival (OS) rates of 170.4 months vs. 5.23 months (p = 0.004). Multiplicity, eloquent area involvement, initial tumor bleeding, LM, hydrocephalus, and Karnofsky Performance Score < 80 at diagnosis were associated with negative outcomes in progression-free survival and OS. Adjuvant radiotherapy for patients who had LM and for those who cannot undergo grossly total tumor removal resulted in a good outcome. Conclusions GTR demonstrated better outcomes for solitary PIMM. For recurrent tumors, aggressively repeated surgical resection remained beneficial for selected cases. Adjuvant radiotherapy was a treatment option for LM following operation. We proposed a possible treatment algorithm for solitary PIMM.

Role of palliative radiotherapy in bleeding control in patients with unresectable advanced gastric cancer

Background This study analyzed the clinical results of palliative radiotherapy for bleeding control in patients with unresectable advanced gastric cancer. Methods We retrospectively reviewed the medical records of patients who met the following inclusion criteria between January 2002 and June 2018: histologically proven gastric cancer, gastric tumor bleeding confirmed by upper gastrointestinal endoscopy, and palliative radiotherapy performed for hemostasis. The median radiotherapy dose was 30 Gy, with a daily dose ranging from 1.8 to 3 Gy. Results Sixty-one patients were included in this analysis. The study population was predominantly male (72.1%), with a median age of 62 years (range: 32–92). The median baseline hemoglobin level was 7.1 g/dL, and the most common presenting symptom of gastric tumor bleeding was melena (85.2%). Bleeding control was achieved in 54 (88.5%) patients. The median levels of hemoglobin at 1, 2, and 3 months after completion of radiotherapy were 10.1 g/dL, 10.2 g/dL, and 10.4 g/dL, respectively; these values were significantly different from that before radiotherapy (7.1 g/dL; p < 0.001). The median overall survival was 4.8 months. Among the 54 patients who achieved bleeding control after radiotherapy, 19 (35.2%) experienced re-bleeding during the follow-up period. The median time to re-bleeding was 6.0 months. Multivariate analysis demonstrated that a higher radiation dose (p = 0.007) and additional chemotherapy after radiotherapy (p = 0.004) were significant factors for prolonging the time to re-bleeding. Conclusions Tumor bleeding was adequately controlled by radiotherapy in patients with unresectable advanced gastric cancer.

Application of Transcatheter Arterial Embolization Sequential Surgery in the Treatment of Liver Cancer

Background Preoperative transcatheter arterial embolization (TACE) is conducive to improve the surgery rate and prognosis of hepatocellular carcinoma (HCC) patients. This study aimed to evaluate the reasons and treatment effects of preoperative TACE as well as its influence on the surgery outcome.Method A total of 22 HCC patients (aged 36–68) undergoing TACE sequential surgery were retrospectively reviewed in our centers between January 2018 and August 2020. The parameters reasons, response of tumor to TACE, objective remission rate (ORR) and disease control rate (DCR), downstaging rate, abdominal adhesion and arterial injury were statistically analyzed.Results The reasons of preoperative TACE included downstaging (45.5%, 10/22), bridging therapy (22.7%, 5/22), individual choice (13.7%, 3/22), definite diagnosis (9.1%, 2/22), control of liver tumor bleeding (4.5%, 1/22) and patients with cerebral infarction (4.5%,1/22). A total of 6 complete response (CR) cases (27.3%) and 2 pathological CR (PCR) cases (9.1%) were noted. The ORR was 63.6% (14 / 22) and the DCR 90.9 % (20/22). The success rate of downstaging was 50.0% (6/12) in the patients not aiming at downstaging and 10% (1 /10) in the patients aiming at downstaging. The incidences of abdominal adhesion and arterial injury were 90.9% (20/22) and 45.5% (5/11). Conclusion TACE can be used in preoperative conversion therapy for patients who are temporarily unsuitable for surgery and is more suitable for bridging therapy in liver transplantation patients compared with downstaging due to the high DCR. Surgery should be carried out following TACE even in patients with CR.

Case of Breast Cancer Discovered by Repeated Hematomas After Blunt Trauma to the Breast

Background: Breast hematoma is a manifestation of blunt force injury to the breast. Hematomas without obvious clinical complications were treated conservatively and most of them were self-healing. If there is no history of tumor and no need for emergency treatment, the possibility of tumor is often ignored by clinicians due to the history of trauma. The repeated hematoma in this case did not attract the attention of the clinician, and the lack of cytological and histological examination is a mistake. This case gives us more clues that recurrent hematomas in the breast need to be looked for abnormal causes.Case presentation: This study describes a 62-year-old woman who underwent 6 times of puncture drainage and local compression bandaging for a breast hematoma caused by blunt chest trauma. After each treatment, hematoma was restored to its original size and about 200 ml of blood was drained each time. Hematoma resection was performed 7 months later and the patient was diagnosed with breast cancer. Cytology and histological examination were not performed during the seven months, and patient’s early diagnosis and treatment were delayed. Conclusions: Recurring hematoma of the breast requires active search for the cause of abnormal bleeding, and tumor bleeding is a key point that cannot be ignored.

Colo-pancreaticoduodenectomy for locally advanced colon carcinoma—feasibility in patients presenting with acute abdomen

Background En bloc right hemicolectomy plus pancreaticoduodenectomy (PD) is administered for locally advanced colon carcinoma that invades the duodenum and/or pancreatic head. This procedure may also be called colo-pancreaticoduodenectomy (cPD). Patients with such carcinomas may present with acute abdomen. Emergency PD often leads to high postoperative morbidity and mortality. Here, we aimed to evaluate the feasibility and outcomes of emergency cPD for patients with advanced colon carcinoma manifesting as acute abdomen. Methods We retrospectively reviewed 4898 patients with colorectal cancer who underwent curative colectomy during the period from 1994 to 2018. Among them, 30 had locally advanced right colon cancer and had received cPD. Among them, surgery was performed in 11 patients in emergency conditions (bowel obstruction: 6, perforation: 3, tumor bleeding: 2). Selection criteria for emergency cPD were the following: (1) age ≤ 60 years, (2) body mass index < 35 kg/m2, (3) no poorly controlled comorbidities, and (4) perforation time ≤ 6 h. Three patients did not meet the above criteria and received non-emergency cPD after a life-saving diverting ileostomy, followed by cPD performed 3 months later. We analyzed these patients in terms of their clinicopathological characteristics, the early and long-term postoperative outcomes, and compared findings between emergency cPD group (e-group, n = 11) and non-emergency cPD group (non-e-group, n = 19). After cPD, staged pancreaticojejunostomy was performed in all e-group patients, and on 15 of 19 patients in the non-e-group. Results The non-e-group was older and had a higher incidence of associated comorbidities, while other clinicopathological characteristics were similar between the two groups. None of the patients in the two groups succumbed from cPD. The postoperative complication rate was 63.6% in the e-group and 42.1% in the non-e-group (p = 0.449). The 5-year overall survival rate were 15.9% in the e-group and 52.6% in the non-e-group (p = 0.192). Conclusions Emergency cPD is feasible in highly selected patients if performed by experienced surgeons. The early and long-term positive outcomes of emergency cPD are similar to those after non-emergency cPD in patients with acute abdominal conditions.

Primary Intracranial Malignant Melanomas in Solitary Type: A Tertiary Center Experience

BackgroundSolitary type primary intracranial malignant melanoma (PIMM) is extremely rare but fatal. The optimal treatment algorithm according to clinical relevance of symptoms and outcomes is unclear. This series emphasized the prognostic factors of solitary PIMM and established the treatment algorithm for this rare disease.MethodsPatients with solitary PIMMs were pathologically verified and treated with neurosurgical tumor resection. All solitary PIMMs recruited at our institute received multidisciplinary team care. We analyzed the clinical findings and prognostic factors. ResultsThe study cohort included 10 patients. PIMMs in solitary type impacted middle-aged populations with male predominance in Taiwan. Most patients (80%) presented a single tumor initially. Six patients had progressed to multiplicity after the initial treatment. Rates of tumor bleeding and leptomeningeal metastasis (LM) are high in solitary PIMMs. Patients who had gross-total resection (GTR) had better survival than those who had incomplete resection, with median overall survival (OS) rates of 170.4 months vs. 5.23 months (p = 0.004). Multiplicity, eloquent area involvement, initial tumor bleeding, LM, hydrocephalus, and Karnofsky Performance Score<80 at diagnosis were associated with negative outcomes in progression-free survival and OS. Adjuvant radiotherapy for patients who had LM and for those who cannot undergo grossly total tumor removal resulted in a good outcome.ConclusionsGTR demonstrated better outcomes for solitary PIMM. For recurrent tumors, aggressively repeated surgical resection remained beneficial for selected cases. Adjuvant radiotherapy was a treatment option for LM following operation. We proposed a possible treatment algorithm for solitary PIMM.

Efficacy of a novel hemostatic adhesive powder in patients with upper gastrointestinal tumor bleeding

Background Gastrointestinal tumor bleeding remains a clinical challenge because it is difficult to treat with conventional endoscopic hemostatic options. Recently, an endoscopic hemostatic powder (UI-EWD) was developed and reported to provide effective control of upper gastrointestinal bleeding. The aim of current study was to evaluate the feasibility and efficacy of this novel hemostatic powder in tumor bleeding. Methods A total of 41 consecutive patients with upper gastrointestinal tumor bleeding were included. UI-EWD was applied in all patients as an auxiliary hemostatic method as a salvage therapy or monotherapy during endoscopic treatment. Hemostasis success rates, adverse event related to UI-EWD, and rates of re-bleeding were evaluated. Results In all cases, UI-EWD application was successful at tumor bleeding sites. Immediate hemostasis occurred in 40/41 (97.5%) patients, and re-bleeding within 28 days occurred in 10 of 40 (22.5%) patients that achieved initial hemostasis. The success rate of immediate hemostasis for UI-EWD monotherapy was 100% (23/23). The re-bleeding rate at 28 days after UI-EWD monotherapy was 26.1% (6/23). No adverse events associated with UI-EWD application were encountered. Conclusions The success rate of UI-EWD for immediate hemostasis in cases of GI tumor bleeding was excellent and UI-EWD produced promising results with respect to the prevention of re-bleeding. Based on these results, we suggest that UI-EWD be considered an effective salvage therapy or even monotherapy for GI tumor bleeding.