Spatially fractionated radiotherapy in the era of immunotherapy Review


Authors: McMillan, M. T.; Khan, A. J.; Powell, S. N.; Humm, J.; Deasy, J. O.; Haimovitz-Friedman, A.
Review Title: Spatially fractionated radiotherapy in the era of immunotherapy
Abstract: Spatially fractionated radiotherapy (SFRT) includes historical grid therapy approaches but more recently encompasses the controlled introduction of one or more cold dose regions using intensity modulation delivery techniques. The driving hypothesis behind SFRT is that it may allow for an increased immune response that is otherwise suppressed by radiation effects. With both two- and three-dimensional SFRT approaches, SFRT dose distributions typically include multiple dose cold spots or valleys. Despite its unconventional methods, reported clinical experience shows that SFRT can sometimes induce marked tumor regressions, even in patients with large hypoxic tumors. Preclinical models using extreme dose distributions (i.e., half-sparing) have been shown to nevertheless result in full tumor eradications, a more robust immune response, and systemic anti-tumor immunity. SFRT takes advantage of the complementary immunomodulatory features of low- and high-dose radiotherapy to integrate the delivery of both into a single target. Clinical trials using three-dimensional SFRT (i.e., lattice-like dose distributions) have reported both promising tumor and toxicity results, and ongoing clinical trials are investigating synergy between SFRT and immunotherapies. © 2024 Elsevier Inc.
Keywords: clinical feature; review; nonhuman; neoplasm; neoplasms; cancer immunotherapy; tumor volume; radiotherapy; tumor regression; liver metastasis; immunology; immune response; immunotherapy; radiation dose fractionation; tumor immunity; clinical decision making; cancer control; stereotactic body radiation therapy; radiation dose distribution; low energy radiation; tumor hypoxia; lewis carcinoma; procedures; electromagnetic radiation; high dose radiotherapy; humans; human; microbeam radiation therapy; spatially fractionated radiation therapy; thoracic tumor; dose fractionation, radiation; conventional chondrosarcoma; minibeam radiotherapy
Journal Title: Seminars in Radiation Oncology
Volume: 34
Issue: 3
ISSN: 1053-4296
Publisher: Elsevier Inc.  
Date Published: 2024-07-01
Start Page: 276
End Page: 283
Language: English
DOI: 10.1016/j.semradonc.2024.04.002
PUBMED: 38880536
PROVIDER: scopus
DOI/URL:
Notes: Source: Scopus
Altmetric
Citation Impact
BMJ Impact Analytics
MSK Authors
  1. Simon Nicholas Powell
    331 Powell
  2. John Laurence Humm
    433 Humm
  3. Joseph Owen Deasy
    523 Deasy
  4. Atif Jalees Khan
    152 Khan