Hemostatic radiotherapy can be used to manage tumor bleeding, which occurs in around 10% of advanced cancer cases. Bleeding may occur from various primary sites like the lungs, bladder, or gastrointestinal tract. Tumor vessels lack a proper smooth muscle layer, so pharmacological agents are less effective at controlling bleeding. Radiotherapy can be delivered via external beams or brachytherapy to help stop bleeding. High dose per fraction schedules are typically used, with bleeding generally stopping within 48 hours of a biological effective dose of 20 Gy being delivered. Hemostatic radiotherapy aims to palliate bleeding as an emergency treatment, but can potentially be converted to a curative regimen if a substantial response is seen.

1. Haemostatic Radiotherapy
Dr. Aastha Shah
MD Radiation Oncology

2. • Tumor bleeding pose a major challenge in
oncology.
• Almost 10% of the advanced tumors present
with bleeding.
• Presentation as: vaginal bleed in gyneclogical
malignancies,hemoptysis in lung
cancers,hematuria in bladder cancers,malena
or fresh bleed in GI tumors and oral cavity
bleeds.

3. • Bleeding may even occur from fungating
lymph node masses,orbital masses.
• Base of tongue tumors typically present with
bleeding at advanced stages and are life
threatening.

4. • Tumor vessels lack proper architecture and
hence do not get easily controlled by
pharmacological drugs like adrenaline as they
lack proper smooth muscle layer and thus do
not constrict and eventually bleed
uncontrollably.

5. • Depending on severity,bleeding can be
managed by:
• Compression bandages
• Adrenaline
• Radiotherapy
• Ligation of bleeders
• Radioembolization
• Transfusion of blood products ultimately.

6. • Radiotherapy can be delivered either via
teletherapy or brachytherapy for hemostatic
purpose.
• The acute control mechanism is via increased
platelet adhesion to vascular endothelium and
long term effect is via vessel fibrosis combined
with tumor shrinkage.

7. • High dose per fraction have been typically used
for hemostatic purpose.Hypofractionation
schedules have proven to be useful for both
tumor control and patient compliance.
• Bleeding generally stops in 24 to 48 hours and
usually after a BED of 20 Gy has been delivered.
• Typical dose schedules:
• 8 Gy/#
• 12 Gy/3#

8. • 15 Gy/5#
• 20 Gy/5#
• 30 Gy/10#
• 40 Gy/20#

9. • The intent of hemostatic RT is palliative so just
the gross bleeding mass with minimum
margin should be treated.
• However after a substantial response if
obtained the regimen can be converted to a
curative one adjusting the BED and dose
fractionation.

10. • Bleeding tumors constitute an oncologic
emergency and hemostatic RT has been used
since ages with a very well response.