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<p>Conventional radiotherapy for bulky tumors is often limited by normal tissue tolerance, restricting dose escalation and increasing toxicity. Spatially Fractionated Radiation Therapy (SFRT), including GRID and Lattice Radiotherapy (LRT), delivers intentionally heterogeneous dose distributions to overcome these limitations. This systematic review summarizes the clinical application, outcomes, and dosimetric variability of SFRT in the treatment of bulky tumors. A systematic literature search of the MEDLINE database was performed for studies published between January 2010 and June 2025. Eligible English-language studies reporting original clinical data on SFRT, including case reports, case series, retrospective analyses, and prospective trials, were included. Data on patient and tumor characteristics, treatment intent, SFRT technique, clinical response, and toxicity were extracted, and methodological quality was assessed using the ROBINS-I framework. Twenty-nine studies involving 513 patients and 553 lesions were included. The most commonly treated sites were the thorax (28.8%), pelvis (24.7%) and abdomen (23.3%), with sarcomas (48.0%) carcinomas (14.5%) and non–small cell lung cancer (10.4%) being the predominant histologies. SFRT was mainly delivered with palliative intent (216 cases). Tumor shrinkage was reported in approximately 80% of lesions, with consistent symptom relief. Treatment-related toxicity was generally mild, with most adverse events graded as 1–2; severe toxicities (Grade ≥ 3) were rare. Despite favorable clinical outcomes and an acceptable safety profile, substantial heterogeneity in dosimetric parameters, including valley-to-peak dose ratio and fractionation schemes, was observed across studies. SFRT appears to be a feasible and effective option for bulky tumors, particularly in the palliative setting. However, the lack of dosimetric standardization and prospective data highlights the need for harmonized protocols and well-designed clinical trials.</p>

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Spatially fractionated radiation therapy for bulky tumors: a systematic review of clinical outcomes and dosimetric challenges

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年5月22日

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  • R. Di Franco,
  • R. Mottareale,
  • D. Pezzulla,
  • S. Mercogliano,
  • V. Borzillo,
  • E. Scipilliti,
  • G. Silvestro,
  • G. De Palma,
  • M. Serra,
  • G. Ametrano,
  • F. Buonanno,
  • C. Arrichiello,
  • V. d’Alesio,
  • M. A. di Franco,
  • S. Cilla,
  • A. Cuomo,
  • E. Cavalcanti,
  • E. Maranzano,
  • C. Donati,
  • F. Cellini,
  • V. Ravo

摘要

Conventional radiotherapy for bulky tumors is often limited by normal tissue tolerance, restricting dose escalation and increasing toxicity. Spatially Fractionated Radiation Therapy (SFRT), including GRID and Lattice Radiotherapy (LRT), delivers intentionally heterogeneous dose distributions to overcome these limitations. This systematic review summarizes the clinical application, outcomes, and dosimetric variability of SFRT in the treatment of bulky tumors. A systematic literature search of the MEDLINE database was performed for studies published between January 2010 and June 2025. Eligible English-language studies reporting original clinical data on SFRT, including case reports, case series, retrospective analyses, and prospective trials, were included. Data on patient and tumor characteristics, treatment intent, SFRT technique, clinical response, and toxicity were extracted, and methodological quality was assessed using the ROBINS-I framework. Twenty-nine studies involving 513 patients and 553 lesions were included. The most commonly treated sites were the thorax (28.8%), pelvis (24.7%) and abdomen (23.3%), with sarcomas (48.0%) carcinomas (14.5%) and non–small cell lung cancer (10.4%) being the predominant histologies. SFRT was mainly delivered with palliative intent (216 cases). Tumor shrinkage was reported in approximately 80% of lesions, with consistent symptom relief. Treatment-related toxicity was generally mild, with most adverse events graded as 1–2; severe toxicities (Grade ≥ 3) were rare. Despite favorable clinical outcomes and an acceptable safety profile, substantial heterogeneity in dosimetric parameters, including valley-to-peak dose ratio and fractionation schemes, was observed across studies. SFRT appears to be a feasible and effective option for bulky tumors, particularly in the palliative setting. However, the lack of dosimetric standardization and prospective data highlights the need for harmonized protocols and well-designed clinical trials.