What is your general approach to treating bleeding gastric masses with palliative RT?

We once had a patient with stage IV NHL who had transfusion-dependent bleeding from a pesky gastric mass that was chemo-resistant. It turned into a fatal complication, so it was presented as an educational case at ASTRO. We gave 4 Gy x 1 which stopped the bleeding within 24h, and switched to 3 Gy x 9 to finish. By day #3, he developed abd pain and went urgently to the OR after hours. Our empathy drove us, my resident and I, to scrub in to see what it looked like from within. A fist-sized hole was present, which despite repair left him in the ICU. A few days later, his wife opted to withdraw care since he had truly undergone a long road of care and was already DNR.

We did an M&M and found that pre-radiotherapy, a diagnostic CT had demonstrat...

In my experience, I have often used 300 cGy x 10 if carcinoma type tumor, but lower daily dose (200-250 cGy) if lymphatous type tumor.

Again -> I now try to always consider "Goals of Care" issues like... the extent of cancer/extent of repeated transfusions/patients' performance status/life expectancy/etc...

The only fear I have had in these specific clinical scenarios is the potential for stomach perforation at some later point if the patient is not "actively terminal" soon enough. That is, will the patient live long enough to see a tumor response to the extent of creating a stomach defect and its harsh clinical consequences? So, for me, it is helpful knowing if the mass is mostly an endo-phytic tumorous mass (high perforation potential) vers...

Although I've never seen a gastric perforation, even in the extensive preoperative chemoradiation experience from M.D. Anderson, I agree with the comments above. I usually give 30 Gy in 10 fx to a generously contoured GTV with a 15 mm PTV margin.

Sometimes bleeding happens in patients with localized disease at presentation. In those situations where surgery could be indicated, I give 1.5 Gy BID to a dose of 45 Gy over 3 weeks treating the regional nodes as well. The bleeding almost always stops around 20 Gy. I will give patients a long 5-day weekend at that time to limit the acute toxicity, and then complete the treatment.