Radiotherapy as an antihemorrhagic approach in gastric cancer: the RANTIGA study

INTRODUCTION: Gastric bleeding is a major symptom of locally advanced gastric cancer and a significant cause of mortality. Management options include surgery, endoscopic interventions, embolization and radiotherapy (RT). Although palliative RT appears effective for hemorrhage control, evidences are limited to underpowered retrospective studies from Asia, with issues of patient heterogeneity and response evaluation criteria. This study is a multicenter retrospective analysis carried out across Italian radiation oncology centers to evaluate real-world outcomes of hemostatic RT in patients with bleeding gastric cancer. METHODOLOGY: Clinical and dosimetric data were retrospectively collected for patients with active bleeding gastric cancer treated across twelve Italian radiation oncology centers. The primary endpoint was to evaluate hemoglobin stabilization or improvement at four weeks post-treatment. Secondary outcomes included treatment parameters, acute toxicity profile and time to rebleeding. RESULTS: Between January 2018 and October 2024, 100 patients receiving hemostatic RT were collected for the analysis. The median age was 77 years, 68% of cases had advanced disease and 41% of patients were pretreated with chemotherapy. The most frequently administered dose was 39 Gy BED10 (range: 9.6-53.1) with a schedule of 30 Gy in 10 fractions. The primary endpoint was achieved in 95/100 patients (95%) indicating stabilization or improvement in Hb levels without the need for post-treatment transfusions. Only 12 patients experienced acute toxicity, of whom 2 (3.3%) presenting grade 3 nausea. Rebleeding symptoms occurred in 38.5% of cases (median interval of 164 days). CONCLUSION: This national, retrospective, multicenter study suggests that palliative gastric RT is a feasible, effective and well-tolerated approach in this cohort of patients with bleeding gastric cancer, providing hemostatic control and stabilizing hemoglobin levels. Prospective trials are warranted to better define the role of RT, particularly in terms of dose and fractionation based on the disease setting and patient characteristics.