Lattice Radiation Therapy in clinical practice: A systematic review. (March 2023)

• Record Type: Journal Article
• Authors: Iori, Federico; Cappelli, Anna; D'Angelo, Elisa; Cozzi, Salvatore; Ghersi, Sebastiano Finocchi; De Felice, Francesca; Ciammella, Patrizia; Bruni, Alessio; Iotti, Cinzia
• Is Part Of: Clinical and translational radiation oncology. Volume 39(2023)
• Publication Date: 2023-03
• Subjects: Lattice radiation therapy -- Lattice radiotherapy -- Spatially fractionated radiotherapy -- Abscopal effect -- Bulky -- Radiotherapy -- Radiation therapy; LRT Lattice Radiation Therapy -- SFRT Spatially Fractionated Radiation Therapy -- OAR Organ At Risk -- TCP Tumor Control Probability; Cancer -- Radiotherapy -- Periodicals; Oncology -- Periodicals; Cancer -- Radiotherapy; Oncology; Radiation Oncology; Neoplasms -- radiotherapy; Translational Medical Research; Periodicals; Electronic journals; Periodicals; 616.9940642
• DOI: 10.1016/j.ctro.2022.100569
• Languages: English
• ISSNs: 2405-6308

Abstract

Highlights: Lattice Radiation Therapy (LRT) is a type of spatially fractionated radiation therapy that allows delivering ablative doses to large lesions without an increased toxicity, by alternating high-dose and low-dose areas as peaks and valleys. Different LRT approaches are present in Literature and they can be defined as exclusive LRT, hybrid LRT, and metabolism guided hybrid LRT. Available data seems to confirm LRT safety, especially for exclusive LRT. Despite an interesting median lesions reduction approximately above 50 % 3–6 months after LRT, the very low level of evidence and the studies heterogeneity preclude drawing definitive conclusions on LRT efficacy. Abstract: Purpose: Lattice radiation therapy (LRT) is an innovative type of spatially fractionated radiation therapy. It aims to increase large tumors control probability by administering ablative doses without an increased toxicity. Considering the rising number of positive clinical experiences, the objective of this work is to evaluate LRT safety and efficacy. Method: Reports about LRT clinical experience were identified with a systematic review conducted on four different databases (namely, Medline, Embase, Scopus, and Cochrane Library) through the August 2022. Only LRT clinical reports published in English and with the access to the full manuscript text were considered as eligible. The 2020 update version PRISMA statement was followed. Results: Data extraction was performed from 12 eligible records encompassing 7 case reports, 1 case series, and 4 clinical studies. 81 patients (84 lesions) with a large lesion ranging from 63.2 cc to 3713.5 cc were subjected to exclusive, hybrid, and metabolism guided LRT. Excluding two very severe toxicity with a questionable relation with LRT, available clinical experience seem to confirm LRT safety. When a complete response was not achieved 3–6 months after LRT, a median lesion reduction approximately ≥50 % was registered. Conclusion: This systematic review appear to suggest LRT safety, especially for exclusive LRT. The very low level of evidence and the studies heterogeneity preclude drawing definitive conclusions on LRT efficacy, even though an interesting trend in terms of lesions reduction has been described.