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Related Experiment Video

Updated: Jan 15, 2026

Proton Therapy Delivery and Its Clinical Application in Select Solid Tumor Malignancies
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Novel Gradient-based Approach to Spatially Fractionated Radiotherapy: Implementation and Preliminary Clinical

Manuel Santos Ortega1, Diana Guevara Barrera1, Damian Guirado Llorente2,3

  • 1Radiation Oncology, Hospital Clínica Benidorm, Benidorm, ESP.

Cureus
|October 8, 2025
PubMed
Summary
This summary is machine-generated.

Spatial Stepwise Gradient Radiation Therapy (2SG-RT) offers a promising new approach for bulky tumors, improving treatment response and symptom relief with minimal toxicity. This novel technique enhances dose delivery and may stimulate immune responses, warranting further investigation.

Keywords:
bulky tumorsgradient-based radiotherapyheterogeneous dose distributionpalliativespatially fractionated radiation therapy

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Area of Science:

  • Radiation Oncology
  • Medical Physics
  • Oncology

Background:

  • Bulky tumors present treatment challenges due to hypoxia, radioresistance, and dose delivery issues.
  • Spatially Fractionated Radiation Therapy (SFRT) improves outcomes by creating heterogeneous dose distributions.
  • A novel gradient-based SFRT, spatial stepwise gradient radiation therapy (2SG-RT), is introduced to simplify planning and clinical integration.

Purpose of the Study:

  • To evaluate the feasibility and clinical outcomes of 2SG-RT for bulky tumors.
  • To assess treatment response, toxicity, and potential immune-mediated effects.
  • To compare the biological dose delivered by 2SG-RT to conventional fractions.

Main Methods:

  • Twenty-nine patients with bulky tumors received 2SG-RT using nested planning target volumes (PTVs) for dose escalation.
  • Treatment involved intensity-modulated radiation therapy (IMRT) or volumetric modulated arc therapy (VMAT) followed by conventional external beam radiation therapy (EBRT).
  • PET-CT or CT guided target delineation based on hypoxic/necrotic regions; standard prescriptions ranged from 3-12 Gy across PTVs.

Main Results:

  • Median tumor volume reduction was 75% with complete response in 34.5% and partial response in 48.3% of patients.
  • Symptom relief was achieved in 75.8% of patients, with no grade 3-4 toxicities reported.
  • Initial 2SG-RT fractions delivered a 106% higher biological dose compared to conventional fractions.

Conclusions:

  • 2SG-RT is a feasible and adaptable SFRT approach for diverse bulky tumors, enhancing dose delivery efficiency.
  • Preliminary outcomes suggest potential immune-mediated effects, meriting further research.
  • Prospective comparative studies are needed to validate 2SG-RT's clinical impact and long-term benefits.