Hemostatic radiotherapy uses single high doses or fractionated lower doses of external beam radiation to control tumor bleeding. Radiation works by shrinking the tumor and relaxing its aggressiveness, which stops bleeding in 80% of patients within 24-48 hours of treatment starting. Studies have found hemostatic radiotherapy effective at controlling hemorrhaging in 78-100% of advanced cancer patients, usually with doses of 4-10 Gy in a single fraction or 30 Gy over 10 fractions. While radiation achieves short-term hemostasis, most patients experience local recurrence or metastases within two years.

1. Hemostatic Radiotherapy
DR KIRAN KUMAR BR

2. Hemostasis
Hemostasis is a process or steps undertaken to stop the bleeding

3. Why does tumor bleeds?
• Bleeding may result from
• Local vessel damage
• Invasion or from systemic processes such as disseminated intravascular coagulopathy
(DIC)
• Abnormalities in platelet functioning and number.

5. Hemostatic Radiotherapy
• Single fractions (6 – 8 Gy) of external beam radiotherapy can achieve
control of hemorrhage in 80% of patients
• Delivering radiation shrinks the tumor thus the aggressiveness of the
tumor is relaxed which stops the bleeding

6. • In a bleeding tumor, radiotherapy is mostly started with higher doses per
fraction (3–5 Gy) if required and then continued with conventionally fractionated
radiotherapy, possibly in combination with palliative chemotherapy.
• Usually, tumor bleeding stops within 24 to 48 hours after the beginning of
irradiation or after a biologically effective dose of 20 Gy.

7. Investigations
• Smaali et al – hemostatic radiotherapy for bladder cancer
• 30 Gy in 10 fractions or 20 Gy in 5 fractions
• Control of hemorrhage 69%
• Alijabab et al – Hemostatic Radiation Therapy in Advanced Bladder Cancer
• 4-10 Gy in a single fraction
• Control of hemorrhage for 78%

8. • Nomoto et al – effectiveness of hemostatic radiotherapy in treatment of
advanced cancer
• 30 Gy in 10 fractions
• Control of hemorrhage for 83%
• Nikola et al – effectiveness of hemostatic radiotherapy in incurable cancer
• Control of hemorrhage in 89%

9. • Biswal et.al – hemostatic radiotherapy in cervical cancer
• Control of hemorrhage was 100%
• Almost 85% of the patients failed locally in the form of residual, recurrent pelvic
or metastatic disease, within 24 months of follow-up.

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