Evidence map›Paper›PMID 42174670›Full record

SynthesisRadiation oncology (London, England)2026

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

R Di Franco, R Mottareale, D Pezzulla, S Mercogliano, V Borzillo, E Scipilliti, G Silvestro, G De Palma, M Serra, G Ametrano and 11 more

Abstract readSystematic Review
In one paragraph

Synthesis in Radiation oncology (London, England), 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

21 authors.

R Di FrancoDepartment of Radiation Oncology, Istituto Nazionale Tumori - IRCCS Fondazione "G. Pascale", Napoli, Italy.
R MottarealeDepartment of Radiation Oncology, Istituto Nazionale Tumori - IRCCS Fondazione "G. Pascale", Napoli, Italy. rocco.mottareale@istitutotumori.na.it.
D PezzullaRadiation Oncology Unit, Responsible Research Hospital, Campobasso, Italy.
S MercoglianoDepartment of Radiation Oncology, Istituto Nazionale Tumori - IRCCS Fondazione "G. Pascale", Napoli, Italy.
V BorzilloDepartment of Radiation Oncology, Istituto Nazionale Tumori - IRCCS Fondazione "G. Pascale", Napoli, Italy.
E ScipillitiDepartment of Radiation Oncology, Istituto Nazionale Tumori - IRCCS Fondazione "G. Pascale", Napoli, Italy.
G SilvestroDepartment of Radiation Oncology, Istituto Nazionale Tumori - IRCCS Fondazione "G. Pascale", Napoli, Italy.
G De PalmaDepartment of Radiation Oncology, Istituto Nazionale Tumori - IRCCS Fondazione "G. Pascale", Napoli, Italy.
M SerraDepartment of Radiation Oncology, Istituto Nazionale Tumori - IRCCS Fondazione "G. Pascale", Napoli, Italy.
G AmetranoDepartment of Radiation Oncology, Istituto Nazionale Tumori - IRCCS Fondazione "G. Pascale", Napoli, Italy.
F BuonannoDepartment of Radiation Oncology, Istituto Nazionale Tumori - IRCCS Fondazione "G. Pascale", Napoli, Italy.
C ArrichielloDepartment of Radiation Oncology, Istituto Nazionale Tumori - IRCCS Fondazione "G. Pascale", Napoli, Italy.
V d'AlesioDepartment of Radiation Oncology, Istituto Nazionale Tumori - IRCCS Fondazione "G. Pascale", Napoli, Italy.
M A di FrancoDepartment of Radiation Oncology, Istituto Nazionale Tumori - IRCCS Fondazione "G. Pascale", Napoli, Italy.
S CillaMedical Physics Unit, Gemelli Molise Hospital-Università Cattolica del Sacro Cuore, Campobasso, Italy.
A CuomoDivision of Anesthesia and Pain Medicine, Istituto Nazionale Tumori - IRCCS Fondazione "G. Pascale", Napoli, Italy.
E CavalcantiLaboratory Medicine Unit, Istituto Nazionale Tumori - IRCCS Fondazione "G. Pascale", Napoli, Italy.
E MaranzanoUniversity of Perugia, Perugia, Italy.
C DonatiRadiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.
F CelliniDipartimento di Diagnostica per Immagini, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, UOC di Radioterapia Oncologica ed Ematologia, Rome, Italy.
V RavoDepartment of Radiation Oncology, Istituto Nazionale Tumori - IRCCS Fondazione "G. Pascale", Napoli, Italy.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

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.

Indexed as

Dose Fractionation, RadiationNeoplasmsHumansRadiometryRadiotherapy DosageTreatment OutcomeBulky tumorsClinical and dosimetric outcomesGRID and Lattice Radiotherapy (LRT)Spatially Fractionated Radiation Therapy (SFRT)

Identifiers

PMID42174670
PMCPMC13214219

What OpenQuestion holds

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LicenceCC BY-NC-ND
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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.