ReviewCancers2026
Personalized Ultrafractionated Stereotactic Adaptive Radiotherapy in Lung Cancer and Lung Metastases: A Systematic Review.
Review in Cancers, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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.
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.
Who cites it
0 citing papers in PubMed.
No citing paper in PubMed yet.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
10 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
BACKGROUND/
objectivesPersonalized ultrafractionated stereotactic adaptive radiotherapy (PULSAR) delivers high-dose stereotactic radiation as temporally separated pulses, permitting interval response assessment, adaptive replanning, and integration with systemic therapy. Its role in lung cancer and lung metastases remains uncertain. This systematic review synthesizes evidence for PULSAR and PULSAR-like approaches in these settings.
methodsEmbase, MEDLINE, and Cochrane Central were searched from inception to 27 May 2026. Eligible records included clinical studies, trial registries, dosimetric simulations, and preclinical studies. Evidence was stratified into five tiers, with lung-target clinical studies considered direct evidence. Design-appropriate tools were used to assess risk of bias, and certainty was evaluated using a GRADE-informed approach.
resultsFifteen records were included: five lung-target clinical reports, one brain-metastasis clinical report, one patient-derived dosimetric simulation, five trial registry records, and three preclinical or computational modelling reports. Clinical evidence comprised small cohorts, case reports, and abstracts. True PULSAR regimens used three to five high-dose pulses separated by three- to four-week intervals with CBCT- or MRI-guided adaptive replanning. Studies suggested technical deliverability, interval tumour regression, and organ-at-risk dose reductions. One lung cohort reported 100% 1-year local control, but comparative safety and efficacy were not established. Pulmonary-function and quality-of-life data were sparse. Preclinical studies supported schedule-dependent interactions between pulsed radiation and PD-L1 blockade. Risk of bias was high to critical, and certainty was very low overall.
conclusionsPULSAR is technically deliverable in high-risk patients, but evidence remains preliminary. Prospective comparative trials are needed to define optimal schedules, adaptation triggers, safety, quality of life, and patient selection.
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Registered trials
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