Abstract：
OBJECTIVE: Patients with primary genitourinary (GU), gynecologic (GYN) and gastrointestinal (GI) cancers can develop life-threatening or critical function-threatening symptoms that necessitate emergent intervention with palliative radiotherapy (RT). Unfortunately, research describing the use of RT in this critical setting is lacking. We aimed to review literature describing emergent palliative RT for primary pelvic malignancies and provide a narrative synthesis of relevant studies.
METHODS: A medical librarian searched Ovid MEDLINE, Embase Classic, and Embase databases for relevant English language references from 1946-2022. No restrictions were placed on study type, publication type or date. References for GU, GYN and GI cancers were grouped and synthesized separately.
UNASSIGNED: The treatment of bleeding from primary pelvic tumors was the only indication for emergent RT identified, however, no references reported dedicated cohorts of patients treated for bleeding in the emergent setting. Most references were retrospective single institution studies describing various dose fractionation schemes for non-emergent palliative RT. Outcome measures and response assessment times varied. The latency to hemostasis after RT commencement was not well described; most studies reported outcomes captured weeks or months following treatment. In general, high rates of hemostasis for GU, GYN and GI tumors have been reported following RT schedules ranging from a single fraction to many weeks of fractionated treatments. Bleeding seems to respond more favorably than other symptoms including pain and obstruction.
CONCLUSIONS: Managing bleeding was the only indication for emergent RT identified in our search. Scant data exist that describe the latency to a hemostatic response following RT. This is an important knowledge gap in the literature given how commonly patients are affected by this complication of primary pelvic malignancies.
METHODS: A medical librarian searched Ovid MEDLINE, Embase Classic, and Embase databases for relevant English language references from 1946-2022. No restrictions were placed on study type, publication type or date. References for GU, GYN and GI cancers were grouped and synthesized separately.
UNASSIGNED: The treatment of bleeding from primary pelvic tumors was the only indication for emergent RT identified, however, no references reported dedicated cohorts of patients treated for bleeding in the emergent setting. Most references were retrospective single institution studies describing various dose fractionation schemes for non-emergent palliative RT. Outcome measures and response assessment times varied. The latency to hemostasis after RT commencement was not well described; most studies reported outcomes captured weeks or months following treatment. In general, high rates of hemostasis for GU, GYN and GI tumors have been reported following RT schedules ranging from a single fraction to many weeks of fractionated treatments. Bleeding seems to respond more favorably than other symptoms including pain and obstruction.
CONCLUSIONS: Managing bleeding was the only indication for emergent RT identified in our search. Scant data exist that describe the latency to a hemostatic response following RT. This is an important knowledge gap in the literature given how commonly patients are affected by this complication of primary pelvic malignancies.
摘要：
目标：原发性泌尿生殖系统（GU）患者，妇科(GYN)和胃肠道(GI)癌症可出现危及生命或危及关键功能的症状,需要姑息性放疗(RT)的紧急干预.不幸的是,缺乏描述在这种关键环境中使用RT的研究。我们旨在回顾描述原发性盆腔恶性肿瘤的紧急姑息性RT的文献，并提供相关研究的叙述性综合。
方法：一名医学图书馆员搜索了OvidMEDLINE，EmbaseClassic,和Embase数据库，用于1946-2022年的相关英语参考。对研究类型没有限制，出版物类型或日期。GU的参考资料，将GYN和GI癌症分组并分别合成。
■原发性盆腔肿瘤出血的治疗是唯一确定的紧急RT的指征，然而,没有参考文献报道在急诊环境中治疗出血的患者的专门队列.大多数参考文献是回顾性的单机构研究，描述了非紧急姑息性RT的各种剂量分割方案。结果衡量标准和反应评估时间各不相同。RT开始后止血的潜伏期没有得到很好的描述；大多数研究报告了治疗后数周或数月的结果。总的来说,GU的止血率高，已经报道了GYN和GI肿瘤遵循从单个部分到许多周的分次治疗的RT时间表。出血似乎比其他症状（包括疼痛和阻塞）更有优势。
结论：管理出血是我们搜索中确定的紧急RT的唯一指征。描述RT后止血反应的潜伏期的数据很少。鉴于患者通常受到原发性盆腔恶性肿瘤并发症的影响，这是文献中的重要知识空白。
方法：一名医学图书馆员搜索了OvidMEDLINE，EmbaseClassic,和Embase数据库，用于1946-2022年的相关英语参考。对研究类型没有限制，出版物类型或日期。GU的参考资料，将GYN和GI癌症分组并分别合成。
■原发性盆腔肿瘤出血的治疗是唯一确定的紧急RT的指征，然而,没有参考文献报道在急诊环境中治疗出血的患者的专门队列.大多数参考文献是回顾性的单机构研究，描述了非紧急姑息性RT的各种剂量分割方案。结果衡量标准和反应评估时间各不相同。RT开始后止血的潜伏期没有得到很好的描述；大多数研究报告了治疗后数周或数月的结果。总的来说,GU的止血率高，已经报道了GYN和GI肿瘤遵循从单个部分到许多周的分次治疗的RT时间表。出血似乎比其他症状（包括疼痛和阻塞）更有优势。
结论：管理出血是我们搜索中确定的紧急RT的唯一指征。描述RT后止血反应的潜伏期的数据很少。鉴于患者通常受到原发性盆腔恶性肿瘤并发症的影响，这是文献中的重要知识空白。
