Palliative radiotherapy for gastric cancer–related bleeding: a systematic review and meta-analysis of bleeding response and dose–response relationships

PURPOSE: Palliative radiotherapy is commonly used to control bleeding in advanced gastric cancer; however, the optimal dose-fractionation regimen as well as the dose-response relationship remain unclear. We aimed to evaluate the effectiveness of radiotherapy for gastric cancer-related bleeding and its association with dose fractionation. MATERIALS AND METHODS: We systematically searched PubMed, Scopus, Web of Science, Cochrane Library, and Ichushi-Web for studies published between January 2000 and August 2026 on palliative radiotherapy for gastric cancer-related bleeding. The primary endpoint was bleeding response rate. A random-effects meta-analysis was performed to estimate the pooled response rates. Meta-regression and subgroup analyses were conducted to explore dose-response relationships. Meta-regression was performed using study-level median biologically effective dose (BED) values. Egger's test suggested small study effects (P = 0.012). Meta-regression analysis demonstrated an association between a higher BED and an increased likelihood of response (P = 0.010). Subgroup analyses showed that higher BED categories were associated with higher response rates (P = 0.005). The pooled rebleeding rate was 32.4%. The median overall survival and rebleeding-free survival were 3.8 and 3.4 months, respectively. Radiotherapy was generally well tolerated, with a low incidence of grade ≥ 3 toxicities. CONCLUSIONS: Palliative radiotherapy is an effective and well-tolerated treatment for gastric cancer-related bleeding. Although study-level meta-regression identified a statistical association between higher BED and hemostatic response, this may largely reflect selection bias and methodological limitations rather than a true dose-response relationship. Given the poor prognosis of this population, shorter dose-fractionation regimens are appropriate for many patients, whereas higher-BED regimens remain reasonable for selected patients.