DOI: https://doi.org/10.36347/sjmcr.2026.v14i11.004

Pages: 2414-2419

Radiotherapy (RT) is the reference treatment for localized gastric mucosa-associated lymphoid tissue (MALT) lymphoma that is Helicobacter pylori-negative or persists after eradication. Because the disease is indolent and patients often survive for decades, dose de-escalation has become a central question. This review examines how far the dose can be lowered without losing local control, and what the toxicity gain actually amounts to. Narrative review of prospective trials, large retrospective series and guidelines, with priority given to prospective data and to studies reporting endoscopic, biopsy-based response and graded toxicity. Doses of 24-30 Gy deliver complete response and local control rates that are consistently above 90%. Prospective data in 62 patients (24-25.5 Gy) and a retrospective series of 202 patients (24 vs 30 Gy) suggest that 24 Gy is at least as effective as 30 Gy, with less grade 2 acute toxicity. A single-centre pilot trial of response-adapted 4 Gy in 24 patients reported an 83% complete response rate at one year and 96% three-year local control after selective 20 Gy completion, without grade 3 or higher events. Acute toxicity is mostly mild nausea and dyspepsia. Late risks (cardiac, pancreatic, splenic, renal, second cancers) are dose-dependent in principle but poorly quantified in this specific setting, and follow-up of de-escalated regimens is short. A 24 Gy prescription to the stomach is currently the best-supported standard. Ultra-low-dose 4 Gy with response-adapted completion is promising but remains investigational. Larger, longer, ideally randomized studies with patient-reported outcomes are needed.