RT after gastric perforation

[Trevica]

We have a patient with multifocal gastric Ca (one focus in cardia, one near antrum, causing inflow and outflow obstructions, respectively), who is unable to tolerate the definitive surgery he'll need given multiple recent complications and declining health. Has G & J tubes.

We're considering palliative/definitive RT as part of the management along with chemo, as there is no regional/distant metastatic disease.

Problem is--he's about a month out from a gastric perforation (not related to cancer, I'm told). Likely NSAID induced.

Question: if the ulcer has been patched, and has had 4-6 weeks to heal up, how do folks feel about radiating in this situation?

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[yeasterbunny]

tough question - I want to say it should be ok but I'd probably push for an EGD to actually take a look at the state of things first

 

[evilbooyaa]

He had a gastric perforation but didn't have surgery? That's usually a surgical fix or at least won't get better on it's own. You sure it's not just a gastric ulcer?

If it was an ulcer I'd go ahead after stopping NSAIDs. Pre-RT EGD can't hurt I guess but I'm not sure what you're looking for - you're not going to see a blatant hole into peritoneum on scope exam, otherwise patient would be actively dying.

 

[Trevica]

Oh, it was definitely repaired surgically. The surgery he's not able to tolerate is the gastrectomy...

Thanks for the thoughts.

 

[evilbooyaa]

OK I misunderstood his nonoperability. I think if it's fixed and is 4-6 weeks out, isn't immunosuppressed or have other reasons for not healing appropriately, and patient is feeling well without residual abdominal pain then go for it. I wouldn't repeat EGD routinely.

 

[Palex80]

I'd treat. But it's palliative, so 30 / 3 or something like that sounds reasonable.