Palliative Radiotherapy for Advanced Gastric Cancer
Summary
Palliative radiotherapy has emerged as a pivotal modality in the symptomatic management of advanced gastric cancer, particularly for patients who are unsuitable for curative surgery or intensive systemic therapy. Its principal aim is to alleviate tumour-associated bleeding, pain and obstruction, thus improving quality of life without the expectation of long-term disease control. Treatment is generally delivered as external beam radiotherapy, with dose regimens tailored to patient performance status and symptom burden. Typical schedules range from short-course regimens (e.g. 20–30 Gy in 5–10 fractions) to more protracted courses (30–40 Gy in 10–15 fractions), with consideration given to biologically effective dose (BED) thresholds that correlate with durable hemostasis. Rapid symptom relief often occurs within days to weeks, with acceptable acute toxicity profiles. Modern planning techniques, including three-dimensional conformal radiotherapy and intensity-modulated radiotherapy, allow better sparing of adjacent organs at risk, thereby minimising adverse effects such as nausea, anorexia and gastric mucosal irritation. Integration with endoscopic or embolisation procedures can be considered for refractory bleeding, while concurrent or sequential systemic therapy may enhance tumour response in selected cases. Patient selection remains critical, taking into account performance status, nutritional reserves and life expectancy. Ongoing efforts focus on optimising fractionation, refining dose–response relationships and defining predictive biomarkers to guide individualised treatment strategies on a global scale.
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Palliative Radiotherapy for Advanced Gastric Cancer publication trend
The graph below shows the total number of articles in palliative radiotherapy for advanced gastric cancer across all publications each year (not limited to Nature Index journals).
Technical terms
Biologically effective dose (BED): A calculated metric that accounts for total dose and fractionation to predict radiobiological effect on tumour and normal tissue.
Fractionation: The division of total radiotherapy dose into multiple smaller doses (fractions) delivered over several sessions to optimise tumour control and minimise toxicity.
Haemostasis: The cessation of bleeding; in this context, achieved through radiation-induced vascular damage and tumour shrinkage.
External beam radiotherapy: Delivery of ionising radiation from a source external to the patient, focused on the tumour site using advanced imaging and planning techniques.
References
- Palliative radiotherapy for gastric cancer: a systematic review and meta-analysis. Oncotarget (2017).
- Management of Bleeding from Unresectable Gastric Cancer. Biomedicines (2019).
- Palliative external beam radiotherapy for the treatment of tumor bleeding in inoperable advanced gastric cancer. BMC Cancer (2017).
- Palliative radiotherapy for gastric cancer bleeding: a multi-institutional retrospective study. BMC Palliative Care (2022).
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