Department of Radiation Oncology, Albert Einstein College of Medicine, Bronx, NY.
Executive Medical Physics Associates, Miami, FL.
Semin Radiat Oncol. 2024 Jul;34(3):310-322. doi: 10.1016/j.semradonc.2024.05.002.
Treating radioresistant and bulky tumors is challenging due to their inherent resistance to standard therapies and their large size. GRID and lattice spatially fractionated radiation therapy (simply referred to GRID RT and LRT) offer promising techniques to tackle these issues. Both approaches deliver radiation in a grid-like or lattice pattern, creating high-dose peaks surrounded by low-dose valleys. This pattern enables the destruction of significant portions of the tumor while sparing healthy tissue. GRID RT uses a 2-dimensional pattern of high-dose peaks (15-20 Gy), while LRT delivers a three-dimensional array of high-dose vertices (10-20 Gy) spaced 2-5 cm apart. These techniques are beneficial for treating a variety of cancers, including soft tissue sarcomas, osteosarcomas, renal cell carcinoma, melanoma, gastrointestinal stromal tumors (GISTs), pancreatic cancer, glioblastoma, and hepatocellular carcinoma. The specific grid and lattice patterns must be carefully tailored for each cancer type to maximize the peak-to-valley dose ratio while protecting critical organs and minimizing collateral damage. For gynecologic cancers, the treatment plan should align with the international consensus guidelines, incorporating concurrent chemotherapy for optimal outcomes. Despite the challenges of precise dosimetry and patient selection, GRID RT and LRT can be cost-effective using existing radiation equipment, including particle therapy systems, to deliver targeted high-dose radiation peaks. This phased approach of partial high-dose induction radiation therapy with standard fractionated radiation therapy maximizes immune modulation and tumor control while reducing toxicity. Comprehensive treatment plans using these advanced techniques offer a valuable framework for radiation oncologists, ensuring safe and effective delivery of therapy for radioresistant and bulky tumors. Further clinical trials data and standardized guidelines will refine these strategies, helping expand access to innovative cancer treatments.
治疗耐辐射和体积大的肿瘤具有挑战性，因为它们对标准治疗具有固有抗性，并且体积较大。GRID 和晶格分割辐射治疗（简称 GRID RT 和 LRT）提供了有前途的技术来解决这些问题。这两种方法都以网格状或晶格状的方式提供辐射，形成高剂量峰，周围是低剂量谷。这种模式可以破坏肿瘤的大部分，同时保护健康组织。GRID RT 使用高剂量峰的 2 维模式（15-20 Gy），而 LRT 则提供间隔 2-5 厘米的三维高剂量顶点阵列（10-20 Gy）。这些技术对于治疗多种癌症有益，包括软组织肉瘤、骨肉瘤、肾细胞癌、黑色素瘤、胃肠道间质瘤（GISTs）、胰腺癌、胶质母细胞瘤和肝细胞癌。特定的网格和晶格模式必须根据每种癌症类型进行精心定制，以最大限度地提高峰谷剂量比，同时保护关键器官并最小化附带损伤。对于妇科癌症，治疗计划应与国际共识指南一致，包括同步化疗以获得最佳结果。尽管存在精确剂量学和患者选择的挑战，但使用现有的辐射设备（包括粒子治疗系统）可以以成本效益的方式提供靶向高剂量辐射峰，实现 GRID RT 和 LRT。这种部分高剂量诱导辐射治疗与标准分割辐射治疗的分阶段方法最大限度地提高了免疫调节和肿瘤控制，同时降低了毒性。使用这些先进技术的综合治疗计划为放射肿瘤学家提供了有价值的框架，确保为耐辐射和体积大的肿瘤提供安全有效的治疗。进一步的临床试验数据和标准化指南将完善这些策略，帮助扩大创新癌症治疗的可及性。
