In another case the patient received neoadjuvant temozolomide chemotherapy followed by a wedge resection

of the stomach (29). Three other cases of metastatic gastric melanoma were managed with chemotherapy alone, one reported controlled disease after one course of dacarbazine, nimustine, and cisplatin (30), and two other reports did not state which chemotherapy agents were used (19,31). Radiation therapy has been used to control bleeding in a variety of cancers. Studies have shown radiation therapy to be beneficial in controlling hemoptysis in lung cancer, hematuria in sellectchem bladder cancer, and vaginal bleeding in cervical cancer (10-13), more recently studies on radiation therapy to treat Inhibitors,research,lifescience,medical gastric bleeding have been reported. One retrospective study selleckchem demonstrated a 54% response to bleeding in patients with locally advanced or recurrent gastric cancer who were treated with radiation therapy alone (17). Another

retrospective study demonstrated a 70% response to bleeding in patients who received radiation therapy Inhibitors,research,lifescience,medical with or without concurrent chemotherapy (16). Subsequent studies have focused on the effects of radiation dose in symptomatic palliation. A 2009 retrospective study showed that patients with bleeding from primary gastric cancer who received a dose of greater than or equal to 40 Gy in 16 fractions have statistically significant Inhibitors,research,lifescience,medical improvement in control of bleeding compared to those who received less Inhibitors,research,lifescience,medical than 40 Gy in 16 fractions (15). Most recently a study on patients who received 30 Gy in 10 fractions showed a 73% hemostasis rate. Additionally this study demonstrated that those treated with chemotherapy and radiation had Inhibitors,research,lifescience,medical a significant longer time to rebleeding when compared to those who received radiation therapy alone (14). The case presented marks the first use of standalone radiation therapy as a palliative therapy for persistent upper GI bleeding secondary to primary gastric melanoma.

In the case presented, palliative radiation therapy of 16 Gy in four fractions provided four months of symptomatic relief. In addition, Drug_discovery the patient tolerated a second course of therapy of 9 Gy in three fractions for his rebleeding and is currently asymptomatic. In conclusion, malignant melanoma of the stomach with no identifiable extra-gastric primary is a rare occurrence with surgery being the current mainstay of therapy. In symptomatic patients who are poor surgical candidates, palliative radiation therapy can provide symptomatic relief and improve quality of life. Acknowledgements Disclosure: The authors declare no conflict of interest.
Red meat might be directly linked to the incidence of colorectal cancer or indirectly because diets high in meat may be deficient of other dietary components such as fibre and polyphenols from fruit and vegetables.